A 5-Year Cost-Utility Analysis Comparing Synthetic Cage vs Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy.

Abstract

Retrospective cost-utility analysis. To conduct a cost-analysis comparing SC versus Allo over a five-year time horizon. Synthetic cage (SC) and allograft (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. A decision-analysis model comparing the use of Allo versus SC was developed for a hypothetical 60-year-old patient with cervical spondylotic myelopathy (CSM) 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 5-year period. A probabilistic sensitivity analysis using a Monte Carlo Simulation of 1000 patients was carried out to calculate incremental cost effectiveness ratio (ICER) and net monetary benefits (INMB). One-way deterministic sensitivity analysis was performed to estimate the contribution of individual parameters to uncertainty in the model. The use of Allo was favored in 81.6% of the iterations at a societal willing-to-pay threshold (WTP) of 50,000 USD/QALY. Allo dominated (higher net QALYs and lower net costs) in 67.8% of the iterations. The INMB in the Allo group was 2,650 USD at a WTP 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. Cost-utility analysis suggests that Allograft maybe a more cost-effective option compared to synthetic cages in adult patients undergoing ACDF for CSM.