Cost-effectiveness of anterior cervical discectomy and fusion is “acceptable”

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Leah Carreon, Norton Leatherman Spine Center, Louisville, USA, presented the results of a study at IMAST that showed, after five years, the cost per quality adjusted life year (QALY) gained for anterior cervical discectomy and fusion for single-level anterior cervical discectomy and fusion (ACDF) falls within an acceptable range for cost-effectiveness

Carreon explained that economic value is an increasingly important component of healthcare policy decision making. She said: “So, the objective of the study was to determine the cost per QALY gained for single-level instrumented ACDF over five years.”


Carreon et al reviewed data from 352 patients (182 females; 170 males; mean age 45 years) enrolled in the control arm (ie, ACDF) of IDE trials evaluating cervical total disc replacement and determined health state utility values using the SF-6D. Mean post-operative QALY gained after one year was 0.16, 0.18 after two years, 0.17 after three years, 0.18 after four years and five years. The cumulative QALY gained over five years was 0.87. Carreon stated that the cost per QALY gained after five years was between USD $23, 500 and USD $24,500 (€19,349.34–20,174.07), which was below the previously reported figure of USD $32,560 (€26,838.12) and fell below the traditional cost effectiveness threshold of US $50,000–10,000 (€41,174.18–82,344.11) or the US per capita GDP of US $47,000 (€38,246.12).

Carreon concluded: “This is one of the few studies that report on cost-effectiveness for single-level instrumented ACDF at five years after surgery. The cost per QALY falls within an acceptable range for cost-effectiveness. Indeed, data at five-year follow-up suggests reasonable durability and therefore potential for further improvement in cost-effectiveness in the future.”