title: The 5-year cost-effectiveness of anterior cervical discectomy and fusion and cervical disc replacement: a Markov analysis.
abstract: METHODS
  A Markov state-transition model was developed to evaluate the cost-effectiveness of anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) at 5 years.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of ACDF and CDR at 5 years.
  
  
  BACKGROUND
  ACDF and CDR are surgical options for the treatment of an acute cervical disc herniation with associated myelopathy/radiculopathy. Cost-effectiveness analysis provides valuable information regarding which intervention will lead to a more efficient utilization of health care resources.
  
  
  METHODS
  Outcome and complication probabilities were obtained from existing literature. Physician costs were based on a fixed percentage of 140% of 2010 Medicare reimbursement. Hospital costs were determined from the Nationwide Inpatient Sample. Utilities were derived from responses to health state surveys (Short Form 36) at baseline and at 5 years from the treatment arms of the ProDisc-C trial. Incremental cost-effectiveness ratios were used to compare treatments. One-way sensitivity analyses were performed on all parameters within the model.
  
  
  RESULTS
  CDR generated a total 5-year cost of $102,274, whereas ACDF resulted in a 5-year cost of $119,814. CDR resulted in a generation of 2.84 quality-adjusted life years, whereas ACDF resulted in 2.81. The incremental cost-effectiveness ratio was -$557,849 per quality-adjusted life year gained. CDR remained the dominant strategy below a cost of $20,486. ACDF was found to be a cost-effective strategy below a cost of $18,607. CDR was the dominant strategy when the utility value was above 0.713. CDR remained the dominant strategy assuming an annual complication rate less than 4.37%.
  
  
  CONCLUSIONS
  ACDF and CDR were both shown to be cost-effective strategies at 5 years. CDR was found to be the dominant treatment strategy in our model. Further long-term studies evaluating the clinical and quality-of-life outcomes of these 2 treatments are needed to further validate the model.
  
  
  METHODS
  5.
authors.affiliation: *Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, NY; and †Texas Back Institute/Texas Health Research Institute, Plano, TX.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: McAnany
authors.forename: Samuel
authors.initials: S
authors.lastname: Overley
authors.forename: Evan O
authors.initials: EO
authors.lastname: Baird
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hecht
authors.forename: Jack E
authors.initials: JE
authors.lastname: Zigler
authors.forename: Sheeraz A
authors.initials: SA
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000639:trends; D017586:Diskectomy / Q000191:economics* / Q000639:trends; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000191:economics* / Q000601:surgery; D008297:Male; D008390:Markov Chains; D013123:Spinal Fusion / Q000191:economics* / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome