Anterior Cervical Discectomy and Fusion for Adjacent Segment Disease : Clinical Outcomes and Cost Utility of Surgical Intervention
STUDY DESIGN: Retrospective review.
OBJECTIVE: Determine clinical outcomes and cost utility of anterior cervical discectomy and fusion (ACDF) for the treatment of adjacent segment disease (ASD).
SUMMARY OF BACKGROUND DATA: The incidence of symptomatic ASD after ACDF has been estimated to occur in up to 26% of patients. Commonly, these patients will undergo an additional ACDF procedure. However, there are currently no studies available that adequately describe the clinical outcomes or cost utility of performing ACDF for ASD.
METHODS: A retrospective review of 40 patients undergoing ACDF for ASD was performed. Baseline and 2-year neck and arm pain (NRS-NP, NRS-AP), neck disability index (NDI), physical and mental quality of life (SF-12 PCS & MCS), and Zung depression score (ZDS) were assessed. Two-year total neck-related medical resource utilization, amount of missed work, and health-state values were determined. Quality-adjusted life years (QALYs) were calculated from EQ-5D assessments with US valuation. Comprehensive costs (indirect, direct, and total cost) and the value (cost-per-QALY gained) of performing ACDF for ASD were assessed.
RESULTS: Performing ACDF to treat ASD resulted in significant improvements (P<0.05) in NRS-NP, NRS-AP, NDI, SF-12 PCS, and ZDS outcome measures. Patient-reported health states also significantly improved, with a mean cumulative 2-year gain of 0.54 QALYs. The mean 2-year cost of surgery was $32,616 (direct cost: $25,391; indirect cost: $7225). ACDF for the treatment of ASD was associated with a mean 2-year cost per QALY gained of $60,526.
CONCLUSIONS: Performing ACDF for ASD resulted in significant improvements in patient pain, disability, and quality of life. Further, the mean 2-year cost-per-QALY was determined to be $60,526, which suggests surgical intervention to be cost effective. This study is the first to provide evidence that performing an ACDF for ASD is both clinically and cost effective.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
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| Enthalten in: |
Clinical spine surgery - 29(2016), 6 vom: 15. Juli, Seite 234-41 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
O'Neill, Kevin R [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 12.01.2018 Date Revised 09.04.2022 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/BSD.0b013e31828ffc54 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM259948543 |
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| 100 | 1 | |a O'Neill, Kevin R |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Anterior Cervical Discectomy and Fusion for Adjacent Segment Disease |b Clinical Outcomes and Cost Utility of Surgical Intervention |
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| 500 | |a Date Completed 12.01.2018 | ||
| 500 | |a Date Revised 09.04.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a STUDY DESIGN: Retrospective review | ||
| 520 | |a OBJECTIVE: Determine clinical outcomes and cost utility of anterior cervical discectomy and fusion (ACDF) for the treatment of adjacent segment disease (ASD) | ||
| 520 | |a SUMMARY OF BACKGROUND DATA: The incidence of symptomatic ASD after ACDF has been estimated to occur in up to 26% of patients. Commonly, these patients will undergo an additional ACDF procedure. However, there are currently no studies available that adequately describe the clinical outcomes or cost utility of performing ACDF for ASD | ||
| 520 | |a METHODS: A retrospective review of 40 patients undergoing ACDF for ASD was performed. Baseline and 2-year neck and arm pain (NRS-NP, NRS-AP), neck disability index (NDI), physical and mental quality of life (SF-12 PCS & MCS), and Zung depression score (ZDS) were assessed. Two-year total neck-related medical resource utilization, amount of missed work, and health-state values were determined. Quality-adjusted life years (QALYs) were calculated from EQ-5D assessments with US valuation. Comprehensive costs (indirect, direct, and total cost) and the value (cost-per-QALY gained) of performing ACDF for ASD were assessed | ||
| 520 | |a RESULTS: Performing ACDF to treat ASD resulted in significant improvements (P<0.05) in NRS-NP, NRS-AP, NDI, SF-12 PCS, and ZDS outcome measures. Patient-reported health states also significantly improved, with a mean cumulative 2-year gain of 0.54 QALYs. The mean 2-year cost of surgery was $32,616 (direct cost: $25,391; indirect cost: $7225). ACDF for the treatment of ASD was associated with a mean 2-year cost per QALY gained of $60,526 | ||
| 520 | |a CONCLUSIONS: Performing ACDF for ASD resulted in significant improvements in patient pain, disability, and quality of life. Further, the mean 2-year cost-per-QALY was determined to be $60,526, which suggests surgical intervention to be cost effective. This study is the first to provide evidence that performing an ACDF for ASD is both clinically and cost effective | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Wilson, Robert J |e verfasserin |4 aut | |
| 700 | 1 | |a Burns, Katharine M |e verfasserin |4 aut | |
| 700 | 1 | |a Mioton, Lauren M |e verfasserin |4 aut | |
| 700 | 1 | |a Wright, Brian T |e verfasserin |4 aut | |
| 700 | 1 | |a Adogwa, Owoicho |e verfasserin |4 aut | |
| 700 | 1 | |a McGirt, Matthew J |e verfasserin |4 aut | |
| 700 | 1 | |a Devin, Clinton J |e verfasserin |4 aut | |
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