Cost-utility of ASC vs inpatient anterior cervical discectomy, fusion

Editor's Note

This study from researchers at Carolina Neurosurgery and Spine Associates and SpineFirst, Atrium Health, Charlotte, North Carolina, examines the cost-utility of anterior cervical discectomy and fusion (ACDF) performed in an ASC vs an inpatient hospital setting at 1-year follow-up. 

A total of 6,504 patients having 1-to 2-level ACDF in an ASC (520 patients) or an inpatient hospital setting (5,984 patients) were compared—748 patients per cohort were included in the analysis. 

Among the findings: 

• Complication rates and improvements in outcome measures and quality adjusted life-years (QALY) were similar between groups. 
• ACDF in the ASC setting was linked to significantly lower total costs at 1 year for Medicare ($5,879.46) and privately insured ($12,873.97) patients. 
• Incremental cost-effectiveness ratios for inpatient ACDF was $3,674,662 for Medicare and $8,046,231 for privately insured patients. 

The researchers concluded that inpatient ACDF is associated with significant increased total costs compared to the ASC setting, without safety, outcome, or QALY benefits.