The cost-effectiveness of anterior cervical discectomy and fusion and open-door laminoplasty in treatment of multilevel cervical spondylotic myelopathy: A cost-effectiveness analysis
Abstract
Background : ACDF and Laminoplasty are surgical options for the treatment of multilevel cervical spondylotic myelopathy. Many studies tried to compare the results of surgical treatment, but no studies have revealed which one is more cost-effectiveness. The purpose of this study is to evaluate the cost-effectiveness of ACDF and Laminoplasty by using cost-effectiveness analysis.
Objective : The aim of this study is to determine the cost-effectiveness of ACDF and Laminoplasty at 6 months, according to the hospital’s perspective.
Methods : This is a cost-effectiveness analysis. This study was retrospective. The author evaluated 30 consecutive patients (16 patients for the ACDF group and 14 patients for the Laminoplasty group) at Kalasin hospital from 2005-2014. The preoperative JOA score and demographic data of both groups were comparable. The effectiveness was expressed in number of improved JOA score. The hospital costs were determined from total cost of treatment. Cost per effective and incremental cost-effectiveness ratio were used to compare treatments.
Results : ACDF generated an average total hospital cost 90,202 baht, whereas Laminoplasty resulted in total cost 43,018 baht. There was statistically significant difference in both groups, (P<0.001). Both groups significantly improve the JOA score, 6.625±3.22 in ACDF group and 5.928±1.82 in Laminoplasty group. There was no statistically significant difference in both groups, (P=0.481). The cost per effectiveness of ACDF group was 13,615.53 baht and Laminoplasty group was 7,256.09 baht. The incremental cost-effectiveness ratio was 67,754.70 baht per 1 score gained.
Conclusion : Both ACDF and Laminoplasty were shown to be effective treatment at 6 months. However, the improvement by Laminoplasty in this study demonstrate a potentially more cost-effective profile at 6 months. In case that both procedures can be performed, Laminoplasty should be a preferred surgical method to ACDF, according to the hospital’s perspective.
Keyword : Cost-effectiveness analysis, Multilevel CSM, ACDF, Laminoplasty
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จริยา เลิศอรรฆยมณี และ อุบลรัตน ์ สันตวัตร. งานวิจัยประเมินเศรษฐศาสตร์คลินิก. ใน : จริยา เลิศอรรฆยมณี, ประดิษฐ์ สมประกิจ, อุบลรัตน์ สันตวัตร, บรรณาธิการ. งานวิจัยทางคลินิก.กรุงเทพ : ไพศาลศิลป์ การพิมพ์ ; 2543 : 51-70.
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