A health-economic assessment of cervical disc arthroplasty compared with allograft fusion

New interventions are often required to be both clinically effective and economically justifiable. The purpose of the study was to conduct an economic evaluation of the Prestige total cervical disc replacement compared with an instrumented fusion. This health-economic evaluation was conducted using data from a recently completed randomized clinical trial and published sources of cost and wage data. The outcome measures were healthcare costs and work productivity. We defined direct costs (2007 US$) as the sum of the costs of the initial surgery, secondary procedures, and medical devices. Using a societal perspective, we estimated the value of work productivity by multiplying the average daily wage by the number of days of work after surgery. We calculated economic impact as the difference between incremental medical costs and gains in work productivity. The mean initial procedure cost for the arthroplasty group was $111 higher than for the fusion group. On account of fewer secondary procedures, the mean secondary procedure cost for arthroplasty patients was $542 lower than for fusion patients. The total direct cost per patient was therefore $431 lower, on average, in the arthroplasty group than in the fusion group. Arthroplasty patients worked 38 days longer, on average, than fusion patients, yielding an average gain in work productivity of $6547. We found that compared with fusion, arthroplasty was associated with an average total savings of $6978 per patient over 2 years postsurgery.