Department of Orthopaedic Surgery, Norton Leatherman Spine Center, Louisville, KY 40202, USA.
Spine (Phila Pa 1976). 2013 Mar 15;38(6):471-5. doi: 10.1097/BRS.0b013e318273aee2.
Longitudinal cohort. OBJECTIVE.: The purpose of this study is to determine the cost per quality-adjusted life year (cost/QALY) gained for single-level instrumented anterior cervical discectomy and fusion (ACDF) over 5 years.
Economic value is an increasingly important component of health care policy decision making.
Control patients who had undergone ACDF with complete 5-year follow-up data who were part of the Investigational Device Exemption trials for cervical disc arthroplasty were identified. Direct costs for each intervention reported as part of the trial were determined using the 2012 Medicare Fee schedule. Health utility was determined using the Short Form-6D, calculated by transformation from the Short Form-36.
There were 352 patients (182 women, 170 men), mean age was 44.6 years (22-73 yr). Cost per patient for the index ACDF was $15,714. Over 5 years, 41 repeat ACDFs, 15 posterior fusions, 6 foraminotomies, 2 implant removals, 2 hematoma evacuations, and 1 esophageal fistula repair were performed. Mean QALY gained in each year of follow-up was 0.16, 0.18, 0.17, 0.18, and 0.18 for a cumulative 0.88 QALY gain over 5 years. The resultant cost/QALY gain at 1 year was $104,831; $53,074 at year 2; $37,717 at year 3; $28,383 at year 4; and $23,460 at year 5. In this cohort, 11 nerve releases and 26 rotator cuff repairs were done within 5 years after the index ACDF. Subanalysis to include upper extremity procedures was performed. The cost/QALY gained at 1 year including upper extremity procedures was $106,256; $54,622 at year 2; $38,836 at year 3; $29,454 at year 4; and $24,479 at year 5.
Increasing health care costs call for demonstration of cost-effectiveness in order to justify payment for interventions, including ACDFs. This study indicates that at 5-year follow-up, single-level instrumented ACDF is both effective and durable resulting in a favorable cost/QALY gained as compared to other widely accepted health care interventions.
纵向队列研究。目的：本研究旨在确定单节段前路颈椎间盘切除融合术（ACDF）在 5 年内的每例质量调整生命年（cost/QALY）成本。背景资料摘要：经济价值是医疗保健政策决策的一个日益重要的组成部分。方法：确定了接受 ACDF 治疗并具有完整 5 年随访数据的对照患者，这些患者是颈椎间盘置换术的研究性设备豁免试验的一部分。使用 2012 年医疗保险费用表确定作为试验一部分报告的每个干预措施的直接成本。使用从短期表单 36 转换而来的短期表单 6d 确定健康效用。结果：共 352 例患者（女性 182 例，男性 170 例），平均年龄为 44.6 岁（22-73 岁）。指数 ACDF 的每位患者的费用为 15714 美元。5 年内，进行了 41 例重复 ACDF、15 例后路融合术、6 例椎间孔切开术、2 例植入物取出术、2 例血肿清除术和 1 例食管瘘修复术。在随访的每一年中，平均 QALY 增加分别为 0.16、0.18、0.17、0.18 和 0.18，5 年内累计 QALY 增加 0.88。1 年时的成本/QALY 增益为 104831 美元；2 年时为 53074 美元；3 年时为 37717 美元；4 年时为 28383 美元；5 年时为 23460 美元。在这组患者中，11 例神经松解术和 26 例肩袖修复术在 ACDF 后 5 年内进行。进行了包括上肢手术在内的亚分析。包括上肢手术在内的 1 年时的成本/QALY 增益为 106256 美元；2 年时为 54622 美元；3 年时为 38836 美元；4 年时为 29454 美元；5 年时为 24479 美元。结论：不断上升的医疗保健成本要求证明干预措施的成本效益，以证明包括 ACDF 在内的干预措施的支付是合理的。本研究表明，在 5 年随访时，单节段前路颈椎间盘切除融合术是有效且持久的，与其他广泛接受的医疗保健干预措施相比，具有良好的成本/QALY 增益。
