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Cost-utility analysis modeling at 2-year follow-up for cervical disc arthroplasty versus anterior cervical discectomy and fusion: A single-center contribution to the randomized controlled trial

Daniel Warren, Tate Andres, Christian Hoelscher, Pedro Ricart-Hoffiz, John Bendo and Jeffrey Goldstein
International Journal of Spine Surgery January 2013, 7 e58-e66; DOI: https://doi.org/10.1016/j.ijsp.2013.05.001

Article Figures & Data

Tables

  • Table 1

    Summary of demographics

    ACDF (n = 10)CDA (n = 18)P-value
    Gender distribution (M,F)6,49,90.71
    Age*40.3 ± 6.541.9 ± 9.10.63
    BMI*26.2 ± 4.026.9 ± 4.20.63
    ASA (1,2)1,93,150.55
    Operative time (min)*195.7 ± 24.5204.8 ± 24.40.36
    Length of stay (days)*1.2 ± 0.41.4 ± 0.60.39
    Level operated
     C4-502
     C5-6710
     C6-736

    • ↵* Values given as mean ± standard deviation.

  • Table 2

    Summary of NDI scores

    ACDF (n = 10)*CDA (n = 18)*P-value
    Preoperation NDI29.0 ± 7.727.8 ± 6.50.66
    12 months9.4 ± 8.613.1 ± 11.40.52
    24 months7.9 ± 6.714.2 ± 11.30.09

    • ↵* Values given as mean ± standard deviation.

  • Table 3

    Summary of SF-36 scores

    ACDF (n = 10)*CDA (n = 18)*P-value
    Preoperation PCS33.9 ± 7.734.3 ± 7.10.88
    12 months40.4 ± 8.543.1 ± 9.00.57
    24 months43.5 ± 8.542.4 ± 8.60.72
    Preoperation MCS26.7 ± 11.831.4 ± 9.20.25
    12 months47.4 ± 6.238.9 ± 13.60.07
    24 months44.3 ± 7.238.6 ± 12.20.20

    • ↵* Values given as mean ± standard deviation.

  • Table 4

    Summary of utility values

    ACDF (n = 10)*CDA (n = 18)*P-value
    NDI
    Preoperation utility0.49 ± 0.10.50 ± 0.10.66
    12 months0.61 ± 0.210.65 ± 0.120.56
    24 months0.70 ± 0.10.64 ± 0.110.11
    Total QALYs 1 year0.16 ± 0.150.13 ± 0.110.57
    Total QALYS 2 years0.37 ± 0.230.27 ± 0.20.27
    SF-36
    Preoperation utility0.47 ± 0.100.51 ± 0.120.34
    12 months0.72 ± 0.130.68 ± 0.170.52
    24 months0.71 ± 0.130.68 ± 0.160.69
    Total QALYs 1 year0.23 ± 0.160.15 ± 0.130.15
    Total QALYS 2 years0.47 ± 0.300.32 ± 0.260.19

    • ↵* Values given as mean ± standard deviation.

  • Table 5

    Procedure costs and cost-utility analysis

    ACDF (n = 10)CDA (n = 18)P-value
    Medicare cost*
     Hospital$11,747 ± $1,343$10,015 ± $0<0.00‡
     Surgeon$3107 ± $0$1826 ± $0<0.00‡
     Anesthesia$596 ± $37$610 ± $370.94
     Neuromonitoring$710 ± $57$720 ± $720.70
    Total cost*†$16,162 ± $1337$13,171 ± $106<0.00‡
    NDI
     Cost/QALY—Year 1$101,013$101,315
     Cost/QALY—Year 2$43,681$48,781
     ICER ACDF vs CDA—Year 1$99,700
     ICER ACDF vs CDA—Year 2$18,593
    SF-36
     Cost/QALY—Year 1$70,269$87,806
     Cost/QALY—Year 2$34,387$41,159
     ICER ACDF vs CDA—Year 1$37,387
     ICER ACDF vs CDA—Year 2$19,940

    • Statistically significant.

    • ↵* Values given as mean ± standard deviation.

    • ↵† Hospital cost plus and CPT-based fees for surgeon, anesthesia and neuromonitoring.

    • ↵‡ Statistically significant.

  • Table 6

    Demographics: Single institution patients reviewed for financial modeling

    ACDF (n = 15)CDA (n = 13)P-value
    Age (y)*53 ± 944 ± 100.02†
    Gender distribution0.51
     Male107
     Female56
    Length of Stay (d)*1.3 ± 0.61.3 ± 0.60.9
    ORRC total$11,785 ± $1991$11,847 ± $69040.97
    PORC total$4,451 ± $1694$7385 ± $57320.52
    Hospital cost (HCost)$16,108 ± $2935$16,004 ± $78650.97

    • ↵* Values given as the mean ± standard deviation.

    • ↵† Statistically significant.

  • Table 7

    Cost-utility analysis based on institutional financial modeling

    ACDF (n = 15)CDA (n = 13)P-value
    Hospital cost (HCost)*$16,108 ± $2935$16,004 ± $78650.97
    Physician cost—Surgeon*$3107 ± $0$1826 ± $0<0.01‡
    Physician cost—Anesthesia*$596 ± $37$610 ± $370.94
    Total cost (TCost)†*$19,811 ± $2935$18,440 ± $78650.56
    NDI
     HCost/QALY—Year 1$100,674$123,104
     HCost/QALY—Year 2$43,535$59,272
     TCost/QALY—Year 1$123,818$141,842
     TCost/QALY—Year 2$53,543$68,295
     ICER ACDF vs CDA—Year 1$45,700
     ICER ACDF vs CDA—Year 2$13,710
    SF-36
     HCost/QALY—Year 1$70,034$106,690
     HCost/QALY—Year 2$34,272$50,011
     TCost/QALY—Year 1$86,134$122,930
     TCost/QALY—Year 2$42,151$57,624
     ICER ACDF vs CDA—Year 1$17,138
     ICER ACDF vs CDA—Year 2$9140

    • ↵* Values given as mean ± standard deviation.

    • ↵† Hospital cost plus CPT-based fees for surgeon and anesthesia.

    • ↵‡ Statistically significant.

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Cost-utility analysis modeling at 2-year follow-up for cervical disc arthroplasty versus anterior cervical discectomy and fusion: A single-center contribution to the randomized controlled trial
Daniel Warren, Tate Andres, Christian Hoelscher, Pedro Ricart-Hoffiz, John Bendo, Jeffrey Goldstein
International Journal of Spine Surgery Jan 2013, 7 e58-e66; DOI: 10.1016/j.ijsp.2013.05.001
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