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2013년 12월 8일 일요일

Cost-effectiveness of single-level anterior cervical discectomy and fusion five years after surgery

Brief review


*Title: Cost-effectiveness of single-level anterior cervical discectomy and fusion five years after surgery
단일분절 전방경유 경추 절제 유합술 5 간의 비용 효율성
*Authors: Leah Y. Carreon, Paul A. Anderson, Vincent C. Traynelis, Praveen V. Mummaneni, Steven D. Glassman


STUDY DESIGN
Longitudinal cohort


OBJECTIVE
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.


SUMMARY OF BACKGROUND DATA
Economic value is an increasingly important component of health care policy decision making.


METHODS
Control patients: undergone ACDF (5 yr follow-up)
Direct costs: using the 2012 Medicare Fee schedule.
Health utility: Short Form-6D. (SF-36에서 몇 가지 항목을 발췌하여 수정한 설문지.)


RESULTS
Subject number: 352 patients (182 women+170 men)
Mean age: 44.6 yrs (22-73 yr)
Cost per patient(ACDF): $15,714
-41 repeat ACDFs, 15 posterior fusions, 6 foraminotomies, 2 implant removals, 2 hematoma evacuations, and 1 esophageal fistula repair were performed

Mean QALY:
-1yr fu: 0.16
-2yr fu: 0.18
-3yr fu: 0.17
-4yr fu: 0.18
-5yr fu: 0.18
-cumulative QALY over 5 yrs: 0.88

resultant cost/QALY
-1yr: $104,831
-2yr: $53,074
-3yr: $37,717
-4yr: $28,383
-5yr: $23,460
In this cohort, 11 nerve releases and 26 rotator cuff repairs were done within 5 years after the index ACDF.


CONCLUSION
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.