Higher costs linked with ACDF vs cervical total disc replacement
NEW ORLEANS — Using the Blue Health Intelligence Database, investigators found higher reoperation rates and acute and long-term costs associated with anterior cervical discectomy and fusion compared to cervical disc replacement for patients with single-level disc disease.
“Looking at real-world empirical data outside of Investigational Device Exemption-study conditions, there was a lower rate of reoperation in cervical arthroplasty vs. anterior cervical discectomy and fusion [ACDF] group,” Kris Radcliff, MD, said. “There was a higher cost at 90 days and at the 48-month follow-up period in the ACDF group, and even excluding the cost of the index procedure, the maintenance costs were also higher in the ACDF group.”
Radcliff presented the study findings at the North American Spine Society Annual Meeting, here.
In their retrospective matched cohort analysis, Radcliff and colleagues used ICD-9 codes to identify 327 patients who underwent cervical disc arthroplasty and 6,635 patients who had an ACDF as an index surgical procedure for single-level cervical disc disease following 6 weeks of conservative care.
Although patients in the ACDF group were approximately 3 years older than the arthroplasty group, the investigators saw no significant differences between the groups for gender distribution, incidence of comorbidities, readmission rates up to 90 days and average follow-up of about 26 months. In addition, there were no significant differences between the groups for pain-related complications and the rate of dysphasia was 0% at 24 months in both groups.
The investigators discovered an increased rate of mechanical complications and a statistically significant increased incidence of adverse events in the ACDF group compared to the arthroplasty cohort. The cumulative incidence of reoperation at 4 years was 10% in the ACDF group vs. 5.7% in the arthroplasty group.
Regarding the costs of the procedures, the researchers found index procedure costs and costs at each subsequent follow-up were lower for arthroplasty compared to ACDF.
“As a result, the total costs were lower in the cervical arthroplasty group $34,000 on average at 48 months vs. $39,000 in the ACDF group,” Radcliff said. “To exclude the cost of the index procedure, we broke it down to cost per patient per month, and that was also lower in the cervical arthroplasty group at $1,600 vs. $2,000.”
Radcliff K. Paper #12. Presented at: North American Spine Society Annual Meeting; Oct. 9-12, 2013; New Orleans.
Disclosure: Radcliff has no relevant financial disclosures.