title: Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy.
abstract: BACKGROUND
  Current literature suggests that anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) have comparable clinical outcomes for the treatment of cervical radiculopathy. Given similar outcomes, an understanding of differences in long-term societal costs can help guide resource utilization. The purpose of this study was to compare the relative long-term societal costs of anterior cervical discectomy and fusion (ACDF) to cervical disc arthroplasty (CDA) for the treatment of single level cervical disc disease by considering upfront surgical costs, lost productivity, and risk of subsequent revision surgery.
  
  
  METHODS
  We completed an economic and decision analysis using a Markov model to evaluate the long-term societal costs of ACDF and CDA in a theoretical cohort of 45-65 year old patients with single level cervical disc disease who have failed nonoperative treatment.
  
  
  RESULTS
  The long-term societal costs for a 45-year old patient undergoing ACDF are $31,178 while long-term costs for CDA are $24,119. Long-term costs for CDA remain less expensive throughout the modeled age range of 45 to 65 years old. Sensitivity analysis demonstrated that CDA remains less expensive than ACDF as long as annual reoperation rate remains below 10.5% annually.
  
  
  CONCLUSIONS
  Based on current data, CDA has lower long-term societal costs than ACDF for patients 45-65 years old by a substantial margin. Given reported reoperation rates of 2.5% for CDA, it is the preferred treatment for cervical radiculopathy from an economic perspective.
authors.affiliation: Harvard Combined Orthopaedic Residency Program, Boston, MA.
authors.forename: Ahmer
authors.initials: A
authors.lastname: Ghori
authors.affiliation: Harvard Combined Orthopaedic Residency Program, Boston, MA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Konopka
authors.affiliation: Harvard Combined Orthopaedic Residency Program, Boston, MA.
authors.forename: Heeren
authors.initials: H
authors.lastname: Makanji
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Cha
authors.affiliation: Brigham and Women's Hospital, Boston, MA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
keywords: anterior cervical discectomy and fusion (acdf); cervical disc arthroplasty (cda); cervical radiculopathy