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Lower cost-effectiveness found for ACDF in morbidly obese patients

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SAN DIEGO — Although results of a study presented here showed elective anterior cervical discectomy and fusion yielded significantly improved outcomes in obese patients and showed moderate cost-effectiveness, the procedure was linked with significantly higher costs and lower cost-effectiveness in morbidly obese patients.

Silky Chotai, MD, and colleagues studied 299 consecutive patients who underwent elective anterior cervical discectomy and fusion (ACDF) for degenerative cervical pathology during a 4-year period. Chotai said non-obese patients (BMI less than 35) had a slightly higher postoperative 2-year gain in quality-adjusted life years (QALY), but the difference was not statistically significant compared with obese patients (BMI of 35 and higher). Morbidly obese patients (BMI of 40 and higher) fared worse at all levels.

“Morbidly obese patients had significantly higher costs and lower cost-effectiveness. However, surgery does provide a significant improvement in outcomes. Obesity needs to be taken into consideration as a significant cost modifier as physician and hospital reimbursements move toward a bundled model,” Chotai said at the Cervical Spine Research Society Annual Meeting.

Chotai noted a statistically significant improvement from preoperative scores were seen 2-years postoperatively for arm and neck pain, Neck Disability Index scores and quality of life throughout the patient cohort. Obese patients had a higher 2-year cost-utility of $65,805 per QALY gained compared with $47,634 per QALY gained for non-obese patients.

However, investigators found morbidly obese patients had a significantly higher cost of $168,915 per QALY and significantly lower QALYs (0.15) 2-years postoperatively, Chotai said. – by Robert Linnehan

Reference:

Chotai S, et al. Presentation #10. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 3-5, 2015; San Diego.

Disclosure: Chotai reports no relevant financial disclosures.