Monk Steve H, Hani Ummey, Pfortmiller Deborah, Dyer E Hunter, Smith Mark D, Kim Paul K, Bohl Michael A, Coric Domagoj, Adamson Tim E, Holland Christopher M, McGirt Matthew J
Carolina Neurosurgery & Spine Associates, Charlotte , North Carolina , USA.
SpineFirst, Atrium Health, Charlotte , North Carolina , USA.
Neurosurgery. 2023 Sep 1;93(3):628-635. doi: 10.1227/neu.0000000000002464. Epub 2023 Mar 30.
Anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy (PCF) are the most common surgical approaches for medically refractory cervical radiculopathy. Rigorous cost-effectiveness studies comparing ACDF and PCF are lacking.
To assess the cost-utility of ACDF vs PCF performed in the ambulatory surgery center setting for Medicare and privately insured patients at 1-year follow-up.
A total of 323 patients who underwent 1-level ACDF (201) or PCF (122) at a single ambulatory surgery center were compared. Propensity matching generated 110 pairs (220 patients) for analysis. Demographic data, resource utilization, patient-reported outcome measures, and quality-adjusted life-years were assessed. Direct costs (1-year resource use × unit costs based on Medicare national allowable payment amounts) and indirect costs (missed workdays × average US daily wage) were recorded. Incremental cost-effectiveness ratios were calculated.
Perioperative safety, 90-day readmission, and 1-year reoperation rates were similar between groups. Both groups experienced significant improvements in all patient-reported outcome measures at 3 months that was maintained at 12 months. The ACDF cohort had a significantly higher preoperative Neck Disability Index and a significantly greater improvement in health-state utility (ie, quality-adjusted life-years gained) at 12 months. ACDF was associated with significantly higher total costs at 1 year for both Medicare ($11 744) and privately insured ($21 228) patients. The incremental cost-effectiveness ratio for ACDF was $184 654 and $333 774 for Medicare and privately insured patients, respectively, reflecting poor cost-utility.
Single-level ACDF may not be cost-effective in comparison with PCF for surgical management of unilateral cervical radiculopathy.
颈椎前路椎间盘切除融合术（ACDF）和颈椎后路椎间孔切开术（PCF）是治疗药物难治性神经根型颈椎病最常用的手术方法。目前缺乏比较ACDF和PCF的严格成本效益研究。
评估在门诊手术中心为医疗保险和私人保险患者进行ACDF与PCF手术1年随访时的成本效益。
比较了在单一门诊手术中心接受单节段ACDF（201例）或PCF（122例）的323例患者。倾向匹配产生110对（220例患者）用于分析。评估了人口统计学数据、资源利用、患者报告的结局指标和质量调整生命年。记录直接成本（1年资源使用×基于医疗保险国家允许支付金额的单位成本）和间接成本（缺勤天数×美国日平均工资）。计算增量成本效益比。
两组围手术期安全性、90天再入院率和1年再次手术率相似。两组患者在3个月时所有患者报告的结局指标均有显著改善，并维持到12个月。ACDF队列术前颈部功能障碍指数显著更高，在12个月时健康状态效用（即获得的质量调整生命年）改善显著更大。ACDF与医疗保险患者（11,744美元）和私人保险患者（21,228美元）1年时的总成本显著更高相关。ACDF的增量成本效益比分别为医疗保险患者184,654美元和私人保险患者333,774美元，反映出成本效益较差。
对于单侧神经根型颈椎病的手术治疗，单节段ACDF与PCF相比可能不具有成本效益。
