title: Is anterior cervical fusion with a porous tantalum implant a cost-effective method to treat cervical disc disease with radiculopathy?
abstract: METHODS
  Retrospective cost-effectiveness analysis.
  
  
  OBJECTIVE
  To determine the relative cost-effectiveness of anterior cervical discectomy with fusion (ACDF) using a porous tantalum implant compared with autograft with plating, for single-level cervical disc disease with radiculopathy.
  
  
  BACKGROUND
  ACDF with autograft as an interbody spacer is a generally accepted method to treat degenerated cervical discs with radiculopathy. Concerns about donor site morbidity and the structural characteristics of autograft stimulated investigations of alternative materials. Techniques may differ in their operative risks, complications, outcomes, and resource use.
  
  
  METHODS
  A retrospective review of clinical outcomes and total cost of illness for 5 years postsurgery was performed for 61 consecutive patients enrolled for this study. Twenty-eight patients were treated with single-level ACDF using either a stand-alone, porous tantalum implant, without graft inside the implant, and 33 patients received autograft and plating. A cost-effectiveness analysis comparing the 2 ACDF treatment methods was conducted. This article reports clinical assessments, quality adjusted life years gained, and an incremental cost-effectiveness ratio analysis.
  
  
  RESULTS
  Patients in both cohorts reported improved clinical outcomes, including neck disability index, visual analogue scale, Short-Form 36, Odom's clinical assessment, and patient satisfaction at 5 years postindex surgery. The mean cost of illness for the study period, including preoperative through 5 years postoperative assessments, was 6806 per patient treated with tantalum and 10,143 per patient receiving autograft and plate. Quality-adjusted life years (QALY) gained were 9.41 and 7.14 for the tantalum and control cohorts, respectively. The cost per QALY for the tantalum group was 723 and 1420 for the control group. The incremental cost-effectiveness ratio of ACDF with a porous tantalum implant compared with ACDF with autograft and plate was -1473 per patient per year for the duration of this study.
  
  
  CONCLUSIONS
  This cost-effectiveness analysis reports favorable results for ACDF procedures utilizing a tantalum implant. The data reported suggest that using porous tantalum as a stand-alone device is less costly and more effective than autograft and plate in ACDF procedures.
authors.affiliation: Department of Orthopaedic Surgery, Instituto de Cirugía Ortopédica y Traumatología de Barcelona, Barcelona, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Fernández-Fairen
authors.forename: Antonio
authors.initials: A
authors.lastname: Murcia
authors.forename: Ana
authors.initials: A
authors.lastname: Torres
authors.forename: Daniel
authors.initials: D
authors.lastname: Hernández-Vaquero
authors.forename: Ann M
authors.initials: AM
authors.lastname: Menzie
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D003362:Cost-Benefit Analysis; D017586:Diskectomy / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000191:economics / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000191:economics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016062:Porosity; D019736:Prostheses and Implants; D019057:Quality-Adjusted Life Years; D011843:Radiculopathy / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics / Q000379:methods*; D011795:Surveys and Questionnaires; D013635:Tantalum; D016896:Treatment Outcome
chemical_list: D013635:Tantalum