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Cervical degenerative disease: systematic review of economic analyses.

Abstract：

STUDY DESIGN:Systematic review. OBJECTIVE:To perform an evidence-based synthesis of the literature assessing the cost-effectiveness of surgery for patients with symptomatic cervical degenerative disc disease (DDD). SUMMARY OF BACKGROUND DATA:Cervical DDD is a common cause of clinical syndromes such as neck pain, cervical radiculopathy, and myelopathy. The appropriate surgical intervention(s) for a given problem is controversial, especially with regard to quality-of-life outcomes, complications, and costs. Although there have been many studies comparing outcomes and complications, relatively few have compared costs and, more importantly, cost-effectiveness of the interventions. METHODS:We conducted a systematic search in PubMed/MEDLINE, EMBASE, the Cochrane Collaboration Library, the Cost-Effectiveness Analysis registry database, and the National Health Service Economic Evaluation Database for full economic evaluations published through January 16, 2014. Identification of full economic evaluations that were explicitly designed to evaluate and synthesize the costs and consequences of surgical procedures or surgical intervention with nonsurgical management in patients with cervical DDD were considered for inclusion, based on 4 key questions. RESULTS:Five studies were included, each specific to 1 or more of our focus questions. Two studies suggested that cervical disc replacement may be more cost-effective compared with anterior cervical discectomy and fusion. Two studies comparing anterior with posterior surgical procedures for cervical spondylotic myelopathy suggested that anterior surgery was more cost-effective than posterior surgery. One study suggested that posterior cervical foraminotomy had a greater net economic benefit than anterior cervical discectomy and fusion in a military population with unilateral cervical radiculopathy. No studies assessed the cost-effectiveness of surgical intervention compared with nonoperative treatment of cervical myelopathy or radiculopathy, although it is acknowledged that existing studies demonstrate the cost-effectiveness of surgical intervention for these 2 clinical entities. CONCLUSION:A paucity of high-quality economic literature exists regarding cost-effectiveness of surgical intervention for cervical DDD. Future research is necessary to validate the findings of the few studies that do exist to guide decisions for surgery by the physician and patient with respect to cost-effectiveness. LEVEL OF EVIDENCE:2.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Alvin MD,Qureshi S,Klineberg E,Riew KD,Fischer DJ,Norvell DC,Mroz TE

doi

10.1097/BRS.0000000000000547

subject

Has Abstract

pub_date

2014-10-15 00:00:00

pages

S53-64

issue

22 Suppl 1

eissn

0362-2436

issn

1528-1159

pii

00007632-201410151-00008

journal_volume

pub_type

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Cervical degenerative disease: systematic review of economic analyses.