The Seven-12 months Value-Effectiveness of Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Markov Evaluation.
Backbone (Phila Pa 1976). 2018 Apr 10;:
Authors: Kim JS, Dowdell J, Cheung ZB, Arvind V, Solar L, Jandhyala C, Ukogu C, Ranson W, Jacobs S, McAnany S, Cho SK
STUDY DESIGN: Markov mannequin evaluation.
OBJECTIVE: The purpose of this research was to find out the 7-year cost-effectiveness of single-level anterior cervical discectomy and fusion (ACDF) versus cervical disc substitute (CDR) for the remedy of cervical disc degeneration.
SUMMARY OF BACKGROUND DATA: Each ACDF and CDR are acceptable surgical choices for the remedy of symptomatic cervical disc degeneration. Previous research have demonstrated not less than equal effectiveness of CDR in comparison with ACDF in giant randomized Investigational Gadget Exemption (IDE) research. Brief-term cost-effectiveness analyses at 5 years have prompt that CDR could also be the popular remedy possibility. Nevertheless, adjoining phase illness and different postoperative problems might happen after 5 years following surgical procedure.
METHODS: A Markov mannequin evaluation was used to guage knowledge from the LDR Mobi-C IDE research, incorporating 5 Markov transition states and 7 cycles with every cycle set to a size of 1 yr. Transition state chances have been decided from complication charges, in addition to index and adjoining phase reoperation charges from the IDE research. Uncooked SF-12 knowledge have been transformed to well being state utility values utilizing the SF-6D algorithm for 174 CDR sufferers and 79 ACDF sufferers.
RESULTS: Assuming a super operative candidate who’s 40-years-old and failed acceptable conservative care, the 7-year price was $103,924 for ACDF and $105,637 for CDR. CDR resulted within the era of 5.33 quality-adjusted life-years (QALYs), whereas ACDF generated 5.16 QALYs. Each ACDF and CDR have been cost-effective, however the incremental cost-effectiveness ratio (ICER) was $10,076/QALY in favor of CDR, which was lower than the willingness-to-pay (WTP) threshold of $50,000/QALY.
CONCLUSION: ACDF and CDR are each cost-effective methods for the remedy of cervical disc degeneration. Nevertheless, CDR is the less expensive process at 7 years following surgical procedure. Additional long-term research are wanted to validate the findings of this mannequin.
LEVEL OF EVIDENCE: 1.
PMID: 29642136 [PubMed – as supplied by publisher]