title: Anterior surgical management of single-level cervical disc disease: a cost-effectiveness analysis.
abstract: METHODS
  Cost-effectiveness analysis with decision analysis and meta-analysis.
  
  
  OBJECTIVE
  To determine the relative cost-effectiveness of anterior cervical discectomy with fusion (with autograft, allograft, or spacers), anterior cervical discectomy without fusion (ACD), and cervical disc replacement (CDR) for the treatment of 1-level cervical disc disease.
  
  
  BACKGROUND
  There is debate as to the optimal anterior surgical strategy to treat single-level cervical disc disease. Surgical strategies include 3 techniques of anterior cervical discectomy with fusion (autograft, allograft, or spacer-assisted fusion), ACD, and CDR. Several controlled trials have compared these treatments but have yielded mixed results. Decision analysis provides a structure for making a quantitative comparison of the costs and outcomes of each treatment.
  
  
  METHODS
  A literature search was performed and yielded 156 case series that fulfilled our search criteria describing nearly 17,000 cases. Data were abstracted from these publications and pooled meta-analytically to estimate the incidence of various outcomes, including index-level and adjacent-level reoperation. A decision analytic model calculated the expected costs in US dollars and outcomes in quality-adjusted life years for a typical adult patient with 1-level cervical radiculopathy subjected to each of the 5 approaches.
  
  
  RESULTS
  At 5 years postoperatively, patients who had undergone ACD alone had significantly (P < 0.001) more quality-adjusted life years (4.885 ± 0.041) than those receiving other treatments. Patients with ACD also exhibited highly significant (P < 0.001) differences in costs, incurring the lowest societal costs ($16,558 ± $539). Follow-up data were inadequate for comparison beyond 5 years.
  
  
  CONCLUSIONS
  The results of our decision analytic model indicate advantages for ACD, both in effectiveness and costs, over other strategies. Thus, ACD is a cost-effective alternative to anterior cervical discectomy with fusion and CDR in patients with single-level cervical disc disease. Definitive conclusions about degenerative changes after ACD and adjacent-level disease after CDR await longer follow-up.
  
  
  METHODS
  4.
authors.affiliation: *Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA †Baylor College of Medicine, Houston, TX ‡Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; and §NeuroTexas Institute, Austin, TX.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lewis
authors.forename: Mark A
authors.initials: MA
authors.lastname: Attiah
authors.forename: Neil R
authors.initials: NR
authors.lastname: Malhotra
authors.forename: Mark G
authors.initials: MG
authors.lastname: Burnett
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Stein
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017586:Diskectomy / Q000191:economics* / Q000379:methods*; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000191:economics / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000191:economics / Q000601:surgery*; D011788:Quality of Life; D016896:Treatment Outcome