• A E H Broekema, N F Simões de Souza, GroenR J MRJMDepartment of Neurosurgery, University Medical Centre Groningen, University of Groningen, Postal Box 30.001, 9700 RB, Groningen, The Netherlands., R Soer, M F Reneman, J M A Kuijlen, van AsseltA D IADIDepartment of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., and FACET investigators.
• Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, Postal Box 30.001, 9700 RB, Groningen, The Netherlands. a.e.h.broekema@umcg.nl.
• Eur Spine J. 2024 Aug 1; 33 (8): 308730983087-3098.

PurposeFor cervical nerve root compression, anterior cervical discectomy with fusion (anterior surgery) or posterior foraminotomy (posterior surgery) are safe and effective options. Posterior surgery might have a more beneficial economic profile compared to anterior surgery. The purpose of this study was to analyse if posterior surgery is cost-effective compared to anterior surgery.MethodsAn economic evaluation was performed as part of a multicentre, noninferiority randomised clinical trial (Foraminotomy ACDF Cost-effectiveness Trial) with a follow-up of 2 years. Primary outcomes were cost-effectiveness based on arm pain (Visual Analogue Scale (VAS; 0-100)) and cost-utility (quality adjusted life years (QALYs)). Missing values were estimated with multiple imputations and bootstrap simulations were used to obtain confidence intervals (CIs).ResultsIn total, 265 patients were randomised and 243 included in the analyses. The pooled mean decrease in VAS arm at 2-year follow-up was 44.2 in the posterior and 40.0 in the anterior group (mean difference, 4.2; 95% CI, - 4.7 to 12.9). Pooled mean QALYs were 1.58 (posterior) and 1.56 (anterior) (mean difference, 0.02; 95% CI, - 0.05 to 0.08). Societal costs were €28,046 for posterior and €30,086 for the anterior group, with lower health care costs for posterior (€12,248) versus anterior (€16,055). Bootstrapped results demonstrated similar effectiveness between groups with in general lower costs associated with posterior surgery.ConclusionIn patients with cervical radiculopathy, arm pain and QALYs were similar between posterior and anterior surgery. Posterior surgery was associated with lower costs and is therefore likely to be cost-effective compared with anterior surgery.© 2024. The Author(s).

29 keywords...

hide…