Healthcare Costs Following Anterior Cervical Discectomy and Fusion or Cervical Disc Arthroplasty

Abstract

Study Design. Observational cohort study. Objective. To describe the postoperative costs associated with both ACDF and CDA in the two-year period following surgery. Summary of Background Data. Cervical disc arthroplasty (CDA) has become an increasingly common alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of cervical disc disorders. Although a number of studies have compared clinical outcomes between both procedures, much less is known about the postoperative economic burden of each procedure. Methods. By analyzing a commercial insurance claims database (Marketscan, Merative), patients who underwent one- or two-level ACDF and CDA procedures, between January 1, 2017, and December 31, 2017, were identified and included in the study. The primary outcome was the cost of payments for postoperative management in the two-year period following ACDF or CDA. Identified postoperative interventions included in the study were: (i) physical therapy, (ii) pain medication, (iii) injections, (iv) psychological treatment, and (iv) subsequent spine surgeries. Results. 2,304 patients (age, 49.0±9.4 years; male, 50.1%) were included in the study. 1,723 (74.8%) patients underwent ACDF while 581 (25.2%) underwent CDA. Cost of surgery was similar between both groups (ACDF, $26,819±23,449; CDA, $25,954±20,620; P=0.429). 30-day, 90-day, and two-year global costs were all lower for patients who underwent CDA compared to ACDF ($31,024 vs $34,411, $33,064 vs $37,517, and $55,723 vs $68,113, respectively). Conclusion. Lower two-year healthcare costs were found for patients undergoing CDA compared to ACDF. Further work is necessary to determine the drivers these findings and associated longer-term outcomes.