• Spine · Mar 2023

    Review Case Reports

    A Five-Year Cost-Utility Analysis Comparing Synthetic Cage Versus Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy.

    • Micheal Raad, Amy L Xu, Carlos Ortiz-Babilonia, Majd Marrache, Wesley M Durand, Marc Greenberg, and Amit Jain.
    • Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
    • Spine. 2023 Mar 1; 48 (5): 330334330-334.

    Study DesignRetrospective cost-utility analysis.ObjectiveTo conduct a cost-analysis comparing synthetic cage (SC) versus allograft (Allo) over a five-year time horizon.Summary Of Background DataSC and Allo are two commonly used interbody choices for anterior cervical discectomy and fusion (ACDF) surgery. Previous analyses comparative analyses have reached mixed conclusions regarding their cost-effectiveness, yet recent estimates provide high-quality evidence.Materials And MethodsA decision-analysis model comparing the use of Allo versus SC was developed for a hypothetical 60-year-old patient with cervical spondylotic myelopathy undergoing single-level ACDF surgery. A comprehensive literature review was performed to estimate probabilities, costs (2020 USD) and quality-adjusted life years (QALYs) gained over a five-year period. A probabilistic sensitivity analysis using a Monte Carlo simulation of 1000 patients was carried out to calculate incremental cost-effectiveness ratio and net monetary benefits. One-way deterministic sensitivity analysis was performed to estimate the contribution of individual parameters to uncertainty in the model.ResultsThe use of Allo was favored in 81.6% of the iterations at a societal willing-to-pay threshold of 50,000 USD/QALY. Allo dominated (higher net QALYs and lower net costs) in 67.8% of the iterations. The incremental net monetary benefits in the Allo group was 2650 USD at a willing-to-pay threshold of 50,000 USD/QALY. One-way deterministic sensitivity analysis revealed that the cost of the index surgery was the only factor which significantly contributed to uncertainty.ConclusionCost-utility analysis suggests that Allo maybe a more cost-effective option compared with SCs in adult patients undergoing ACDF for cervical spondylotic myelopathy.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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