Jared D. Ament

Cost-effectiveness of Cervical Total Disc Replacement vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease

IMPORTANCE Cervical total disc replacement (CTDR) was developed to treat cervical spondylosis, while preserving motion. While anterior cervical discectomy and fusion (ACDF) has been the standard of care for 2-level disease, a randomized clinical trial (RCT) suggested similar outcomes. Cost-effectiveness of this intervention has never been elucidated. OBJECTIVE To determine the cost-effectiveness of CTDR compared with ACDF. DESIGN, SETTING, AND PARTICIPANTS Data were derived from an RCT that followed up 330 patients over 24 months. The original RCT consisted of multi-institutional data including private and academic institutions. Using linear regression for the current study, health states were constructed based on the stratification of the Neck Disability Index and a visual analog scale. Data from the 12-item Short-Form Health Survey questionnaires were transformed into utilities values using the SF-6D mapping algorithm. Costs were calculated by extracting Diagnosis-Related Group codes from institutional billing data and then applying 2012 Medicare reimbursement rates. The costs of complications and return-to-work data were also calculated. A Markov model was built to evaluate quality-adjusted life-years (QALYs) for both treatment groups. The model adopted a third-party payer perspective and applied a 3% annual discount rate. Patients included in the original RCT had to be diagnosed as having radiculopathy or myeloradiculopathy at 2 contiguous levels from C3-C7 that was unresponsive to conservative treatment for at least 6 weeks or demonstrated progressive symptoms. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio of CTDR compared with ACDF. RESULTS A strong correlation (R2 = 0.6864; P < .001) was found by projecting a visual analog scale onto the Neck Disability Index. Cervical total disc replacement had an average of 1.58 QALYs after 24 months compared with 1.50 QALYs for ACDF recipients. Cervical total disc replacement was associated with

Standardizing cost-utility analysis in neurosurgery.

2139 greater average cost. The incremental cost-effectiveness ratio of CTDR compared with ACDF was

Cost Utility Analysis of the Cervical Artificial Disc vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease: 5-Year Follow-up.

24,594 per QALY at 2 years. Despite varying input parameters in the sensitivity analysis, the incremental cost-effectiveness ratio value stays below the threshold of

A Novel Quality-of-Life Utility Index in Patients With Multilevel Cervical Degenerative Disc Disease: Comparison of Anterior Cervical Discectomy and Fusion With Total Disc Replacement.

50,000 per QALY in most scenarios (range, -

Medical necessity of routine admission of children with mild traumatic brain injury to the intensive care unit

58,194 to

Sequential Changes of Plasma C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Spine Surgery : Comparison between Lumbar Open Discectomy and Posterior Lumbar Interbody Fusion

147,862 per QALY). CONCLUSIONS AND RELEVANCE The incremental cost-effectiveness ratio of CTDR compared with traditional ACDF is lower than the commonly accepted threshold of

Health impact and economic analysis of NGO-supported neurosurgery in Bolivia

50,000 per QALY. This remains true with varying input parameters in a robust sensitivity analysis, reaffirming the stability of the model and the sustainability of this intervention.

Understanding United States Investigational Device Exemption Studies—Clinical Relevance and Importance for Healthcare Economics

This review seeks to introduce the concept of cost-utility analysis in neurosurgery and to highlight its essential components. It also includes a suggested approach to standardization, which would help bring more credence to this research and potentially affect management choices, reimbursement, and policy.

Comparing the Cost-Effectiveness of Endoscopic and Microscopic Approaches to Transphenoidal Pituitary Surgery

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Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience

Study Design. Decision analysis from prior randomized controlled trial (RCT) data. Objective. To describe the importance of developing baseline utility indices while identifying effective treatment options for cervical spine disease. Summary of Background Data. Cervical total disc replacement (CTDR) was developed to treat cervical spondylosis while preserving motion. Although anterior cervical discectomy and fusion (ACDF) has been the standard of care, a recent RCT suggested similar outcomes for 2-level disease. The quality-of-life benefit afforded by both CTDR and ACDF has never been fully elucidated. The purpose of our investigation was to better define the changes in utility and perceived value for patients undergoing these procedures. Methods. Data were derived from LDRs RCT comparing CTDR and ACDF for 2-level cervical disc disease. Using linear regression, we constructed health states on the basis of the stratification of clinical outcomes used in the RCT, namely, neck disability index and visual analogue scale. Data from SF-12 questionnaires, completed preoperatively and at each follow-up visit, were transformed into utilities using the SF-6D mapping algorithm. SAS v.9.3 was used for the analyses. Results. A strong correlation (R2 = 0.6864, P < 0.0001) was found between neck disability index and visual analogue scale. We constructed 5 distinct health states by projecting neck disability index intervals onto visual analogue scale. A poorer health state was associated with a lower mean utility value whereas a higher health state was associated with a higher mean utility value (P < 0.0001). The difference in preoperative utility between 2-level ACDF and CTDR was not significant (P = 0.1982), and yet, the difference in the postoperative utility between the cohorts was significant (P < 0.05) at every time point collected from 6 to 60 months. Conclusion. This is the first instance in which distinct utility values have been derived for validated health states related to cervical spine disease. There is substantial potential for these to become baseline future indices for cost-utility analyses in similar populations. Level of Evidence: 1