Cost comparison of patients with 3-level artificial total lumbar disc replacements versus 360° fusion at 3 contiguous lumbar vertebral levels: an analysis of compassionate use at 1 site of the US investigational device exemption clinical trial

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Fig. 1
Scatter plot comparing in-hospital costs in US dollars (USD) for fusion and ADR treatment groups including instrumentation costs. The total cost for fusion-treated patients was statistically higher than that for ADR patients (P < .0001).
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Fig. 2
Scatter plot comparing in-hospital costs in US dollars (USD) for fusion and ADR treatment groups excluding instrumentation costs. The total cost for fusion-treated patients was statistically higher than that for ADR patients (P < .0001).
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Fig. 3
Comparison of hospital service costs in US dollars (USD) between fusion and ADR treatment groups.
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Fig. 4
One-year postoperative lateral radiograph of 3-level ADR.
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Fig. 5
One-year postoperative lateral radiograph of 3-level circumferential fusion via described operative technique.

Table 1

Subject characteristics related to hospital care/treatment

Table 2

Subject characteristics

Continuous	ADR	Fusion	Significance
Age (mean ± SD) (y)	45.98 ± 9.16	53.12 ± 9.71	P < .01
Body mass index (mean ± SD)	28.28 ± 4.85	29.32 ± 8.00	NS
Currently smoking [n (%)]	5/22 (22.73%)	2/21 (9.52%)	NS
Workers' compensation [n (%)]	4/22 (18.18%)	13/21 (61.90%)	P < .01
Male [n (%)]	15/22(68.18%)	15/21 (71.43%)	NS
Previous lumbar surgery [n (%)]	4/22 (18.18%)	4/21 (19.05%)	NS
Previous chronic condition [n (%)]	18/22 (81.82%)	16/21 (76.19%)	NS
Previous surgery—non-orthopaedic [n (%)]	2/22 (9.09%)	3/21 (14.29%)	NS
Previous surgery—spine [n (%)]	5/22 (22.73%)	4/21 (19.05%)	NS
Previous surgery—other orthopaedic [n (%)]	4/22 (18.18%)	2/21 (9.52%)	NS

Table 3

Operative results

	ADR (n = 22) (mean ± SD)	Fusion (n = 21) (mean ± SD)	Significance
Length of surgery (min)	156.32 ± 58.282	359.2 ± 72.136	P <.0001
Length of anesthesia (min)	219.73 ± 68.523	384.32 ± 88.947	P <.0001
Days in hospital	4.77 ± 1.11	8.00 ± 1.82	P <.0001
Estimated blood loss (mL)	451.36 ± 291.54	2,085.7 ± 845.01	P <.0001
Postoperative Hemovac blood (mL)	9.53 ± 43.65	224 ± 380.26	P <.05
Cell saver return (mL)	138.86 ± 224.83	783.57 ± 366.26	P <.0001
Banked blood return (mL)	22.73 ± 106.60	148.1 ± 287.71	NS
Autologous blood return (mL)	34.09 ± 116.89	363.57 ± 345.32	P <.01

Table 4

Comparison of ADR patient versus fusion patient hospital service costs from surgery through discharge

	ADR (USD) (mean ± SD)	Fusion (USD) (mean ± SD)	Significance
Surgical
^* Implant costs	27,000 ± 000.00	70,460.00 ± 18,663.00	P < .0001
Surgery costs	13,618 ± 5,947.60	39,995 ± 6,030.80	P < .0001
Anesthesia costs	4,980.70 ± 1,275.50	9,738.00 ± 1,804.70	P < .0001
Radiology costs	5,220.80 ± 4,035.90	4,044.90 ± 2,244.10	NS
Blood bank costs	944.17 ± 325.22	2,946.3 ± 1,661.90	P < .0001
Hospital stay
Room and board	8,038.60 ± 3,306.80	16,237.00 ± 8,324.40	P < .01
Pharmacy	9,440.20 ± 3,828.20	17,464.00 ± 5,343.00	P < .0001
Central supply	6,118.90 ± 2,518.40	9067.30 ± 1,868.60	P < .0001
Laboratory costs	2,467.00 ± 2,136.90	3,279.60 ± 1,254.60	NS
In-hospital physical therapy costs	875.79 ± 1,180.50	1,318.00 ± 270.25	P < .05
Other consult costs	2,353.20 ± 2,430.40	2,167.80 ± 1,741.90	NS
Total surgical and hospital costs without implant	54,499.00 ± 15,402.00	107,133.00 ± 20,479	P < .0001
Total surgical and hospital costs with implant (estimated ADR)	81,499.00 ± 15,402.00	177,593.00 ± 24,145.00	P < .0001