Is Surgery for Cervical Spondylotic Myelopathy Cost-Effective?

Keywords: cost effectiveness, spinal stenosis, cervical spine, myelopathy, outcome

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     Surgical intervention for appropriately-selected patients with cervical spondylotic myelopathy (CSM) has demonstrated favourable outcomes. However, the cost-effectiveness of this intervention is unclear.
     This study evaluates the cost-effectiveness of surgery for CSM based on Quality-Adjusted Life Year (QALY) gained, based on data obtained from the AOSpine North America Prospective Multicentre CSM Study.
     As part of a larger prospective multi-centre study, direct costs of medical treatment data for 71 subjects undergoing surgery for CSM at a single institution were retrospectively obtained from the hospital billing data. Utilities were estimated on the entire sample of 278 subjects enrolled in the study using SF-6D derived utilities from 12- and 24-month follow-up information. A ten-year horizon with 3% discounting was applied to health utilities estimates
     The SF-6D scores improved significantly (mean change: .0734; 95% C.I. .0557 to .0912, P < .01) at 12 months andremained unchanged at 24 months. The ten-year discounted QALY gain was .64. Costs of medical treatment were estimated at an average of $21,066 CDN. The estimated cost-utility ratio was calculated as $32,916 CDN per QALY. The sensitivity analysis showed a range from $27,326 to $40,988. These estimates are within the limits of $50,000 for interventions with an acceptable cost-utility ratio.
     This is a retrospective study.
     Surgery for CSM is associated with statistically significant improvement in utility scores as measured by the SF-6D variable.
     The cost per QALY gained would indicate that surgery for CSM is also an acceptable cost effective procedure.


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