Neck Fusion: Is It Worth the Price?

The average single-level cervical spine (neck) fusion costs around $15,700. With the rising costs of health care, the question comes up: is this surgery really worth that much money? One way to measure the economic value of this procedure is to calculate the cost per quality-adjusted life year (cost/QALY) gained. Proving cost-effectiveness is necessary in order to justify payment for these procedures -- especially for patients on Medicare.

Here's what cost per quality of life year (cost/QALY) really means. The actual cost of the procedure is the $15,700. But if the procedure works and the patient is pain free and able to return to work and regular daily activities, then there is a clinical benefit of the procedure each year following the surgery. That value can be measured in dollars and cents.

If there are no additional surgeries or added costs, then even a high-cost procedure like cervical spine fusion can gain even more value over time. And any surgical procedure that gains between $50,000 and $100,000 is considered "worth it" (cost-effective).

In this study, surgeons calculated the cost/QALY over a five-year period. There were 352 men and women between the ages of 22 and 73 years old in the study. They each had a single-level instrumented discectomy-and-fusion" class="alinks-link" title="Anterior Cervical Discectomy and Fusion">anterior cervical discectomy and fusion (ACDF) procedure. Instrumented means that hardware such as metal plates and screws were used. Bone graft material was also used to help create a solid spinal fusion.

After analyzing all the data for these 352 patients (including direct costs for additional medical procedures for complications), they found the cost/QALY gained in the first year was $106,000. That figure meets the cost-effective criteria. In the next four years, there was a continued added benefit though it wasn't as high as the first year. For example, in the second year after the surgery, the cost/QALY gained was $54,000. In the third year, it was $38,800 and in the fourth and fifth years, it was between $24,000 (fourth year) and $29,000 (third year).

The conclusion of the study was that single-level neck fusion using the instrumented anterior cervical discectomy and fusion (ACDF) approach has lasting clinical benefit. The five-year favorable cost/QALY provides evidence that the ACDF is cost-effective and durable. In other words, the gains in health benefit are maintained over time adding value with each additional year without problems.

About 18% of the group needed follow-up care. The types of additional surgeries needed by some patients included implant removal, fusion revision, adding a posterior fusion, and removing hematomas (pocket of blood collected in the surgical area). The cost of these procedures was calculated as $20,000 per patient. But even with these added costs, the value added was greater than the additional costs, so the ACDF procedure was still considered cost-effective.

Reference: 

Leah Y. Carreon, MD, MSc, et al. Cost-Effectiveness of Single-Level Anterior Cervical Discectomy and Fusion Five Years After Surgery. In Spine. March 15, 2013. Vol. 38. No. 6. Pp. 471-475.

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