Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

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Fig. 1
Structure of the Markov model. Only one possible revision surgery per patient is assumed.
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Fig. 2
Sensitivity analysis of long term costs of ACDF versus CDA as influenced by the annual CDA reoperation rate. The average annual reoperation rate for CDA needs to remain below 10.5% for CDA to remain less expensive than ACDF.
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Fig. 3
Sensitivity analysis demonstrating that CDA remains less expensive than ACDF unless peri-operative costs for CDA are significantly higher or costs for ACDF are significantly lower than estimated in the base case.

Table 1

Base Case Key Parameters.

Variable		ACDF		CDA
Transition Probabilities	Annual Probability of Disease Recurrence	5.8%	^{9, 11, 13–15, 23}	2.5%	^{9, 11, 13–15, 23}
	Recurrence at Index Level	65%	^{9, 11, 13–15, 23}	63%	^{9, 11, 13–15, 23}
	Recurrence at Adjacent Level	35%	^{9, 11, 13–15, 23}	37%	^{9, 11, 13–15, 23}
	Perioperative Death	0.07%	^{9, 11, 13–15, 23}	0.07%	^{9, 11, 13–15, 23}
Direct Costs (2012 USD)	Pre-operative Workup^*	$1,188	^{26, 27}	$1,188	^{26, 27}
	Anesthesia Fee^†	$516	^{12, 28}	$516	^{12, 28}
	Surgeon Fee	$2,110	²⁶	$1,675	²⁶
	Surgery and Acute Care^§	$9,735	²⁹	$8,668	²⁹
	Rehab or home health care^¥	$182	^31–33	$36	^31–33
	Medications	$112	³⁰	$112	³⁰
	Annual Monitoring^⋄	$251	²⁶	$251	²⁶
Indirect Costs (2012 USD)	Lost productivity^**	$6,066	^{9, 11, 13, 25}	$4,621	^{9, 11, 13, 25}

↵* Physician visits, plain films, CT, MRI, and pre-operative labs
↵† Based on 106 minutes of intra-operative time
↵§ Surgery technical costs and inpatient stay
↵¥ Based on the percentage of patients that require post-op skilled nursing facility or home health care
↵⋄ Cost of physician visits and imaging for two annual visits
↵** Lost productivity due to recovery from surgery.
Abbreviations: ACDF, anterior cervical discectomy and fusion; CDA, cervical disc arthroplasty; USD, United States Dollars; CT, computed tomography; MRI, magnetic resonance imaging.