scholarly journals Cost-effectiveness of Cervical Total Disc Replacement vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease

JAMA Surgery ◽  
2014 ◽  
Vol 149 (12) ◽  
pp. 1231 ◽  
Author(s):  
Jared D. Ament ◽  
Zhuo Yang ◽  
Pierce Nunley ◽  
Marcus B. Stone ◽  
Kee D. Kim
Keyword(s):  
Cost Effectiveness ◽  
Degenerative Disc Disease ◽  
Total Disc Replacement ◽  
Disc Replacement ◽  
Disc Disease ◽  
Cervical Total Disc Replacement ◽  
Degenerative Disc

scholarly journals Seven-year cost-effectiveness of ProDisc-C total disc replacement: results from investigational device exemption and post-approval studies

2016 ◽  
Vol 24 (5) ◽  
pp. 760-768 ◽  
Author(s):  
Kris Radcliff ◽  
Jason Lerner ◽  
Chao Yang ◽  
Thierry Bernard ◽  
Jack E. Zigler
Keyword(s):  
Cost Effectiveness ◽  
Degenerative Disc Disease ◽  
Total Disc Replacement ◽  
Disc Replacement ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Single Level ◽  
Percentile Method ◽  
Patient Level ◽  
Investigational Device Exemption

OBJECTIVE The purpose of this study was to evaluate the 7-year cost-effectiveness of cervical total disc replacement (CTDR) versus anterior cervical discectomy and fusion (ACDF) for the treatment of patients with single-level symptomatic degenerative disc disease. A change in the spending trajectory for spine care is to be achieved, in part, through the selection of interventions that have been proven effective yet cost less than other options. This analysis complements and builds upon findings from other cost-effectiveness evaluations of CTDR through the use of long-term, patient-level data from a randomized study. METHODS This was a 7-year health economic evaluation comparing CTDR versus ACDF from the US commercial payer perspective. Prospectively collected health care resource utilization and treatment effects (quality-adjusted life years [QALYs]) were obtained from individual patient-level adverse event reports and SF-36 data, respectively, from the randomized, multicenter ProDisc-C total disc replacement investigational device exemption (IDE) study and post-approval study. Statistical distributions for unit costs were derived from a commercial claims database and applied using Monte Carlo simulation. Patient-level costs and effects were modeled via multivariate probabilistic analysis. Confidence intervals for 7-year costs, effects, and net monetary benefit (NMB) were obtained using the nonparametric percentile method from results of 10,000 bootstrap simulations. The robustness of results was assessed through scenario analysis and within a parametric regression model controlling for baseline variables. RESULTS Seven-year follow-up data were available for more than 70% of the 209 randomized patients. In the base-case analysis, CTDR resulted in mean per-patient cost savings of $12,789 (95% CI $5362–$20,856) and per-patient QALY gains of 0.16 (95% CI −0.073 to 0.39) compared with ACDF over 7 years. CTDR was more effective and less costly in 90.8% of probabilistic simulations. CTDR was cost-effective in 99.8% of sensitivity analysis simulations and generated a mean incremental NMB of $20,679 (95% CI $6053–$35,377) per patient at a willingness-to-pay threshold of $50,000/QALY. CONCLUSIONS Based on this modeling evaluation, CTDR was found to be more effective and less costly over a 7-year time horizon for patients with single-level symptomatic degenerative disc disease. These results are robust across a range of scenarios and perspectives and are intended to support value-based decision making.

scholarly journals Posterior Transpedicular Dynamic Stabilization versus Total Disc Replacement in the Treatment of Lumbar Painful Degenerative Disc Disease: A Comparison of Clinical Results

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Tunc Oktenoglu ◽  
Ali Fahir Ozer ◽  
Mehdi Sasani ◽  
Yaprak Ataker ◽  
Cengiz Gomleksiz ◽  
...  
Keyword(s):  
Degenerative Disc Disease ◽  
Total Disc Replacement ◽  
Clinical Results ◽  
Dynamic Stabilization ◽  
Disc Replacement ◽  
Disc Prosthesis ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Duration Of Surgery ◽  
The Mean

Study Design. Prospective clinical study.Objective. This study compares the clinical results of anterior lumbar total disc replacement and posterior transpedicular dynamic stabilization in the treatment of degenerative disc disease.Summary and Background Data. Over the last two decades, both techniques have emerged as alternative treatment options to fusion surgery.Methods. This study was conducted between 2004 and 2010 with a total of 50 patients (25 in each group). The mean age of the patients in total disc prosthesis group was 37,32 years. The mean age of the patients in posterior dynamic transpedicular stabilization was 43,08. Clinical (VAS and Oswestry) and radiological evaluations (lumbar lordosis and segmental lordosis angles) of the patients were carried out prior to the operation and 3, 12, and 24 months after the operation. We compared the average duration of surgery, blood loss during the surgery and the length of hospital stay of both groups.Results. Both techniques offered significant improvements in clinical parameters. There was no significant change in radiologic evaluations after the surgery for both techniques.Conclusion. Both dynamic systems provided spine stability. However, the posterior dynamic system had a slight advantage over anterior disc prosthesis because of its convenient application and fewer possible complications.

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