Houston Methodist. Leading Medicine

Neck FAQ

Question:

My cousin had a neck fusion last year that cost about $20,000. He can't move or turn her neck but he says at least he doesn't hurt anymore. That seems like a lot of money to me. You could buy a boatload of painkillers for that and go on vacation. I didn't say that to him but I wonder what you think.

Answer:

The average single-level cervical spine (neck) fusion costs around $15,700 so that $20,000 figure is in the ball park. With the rising costs of health care, the question does come up: is this surgery really worth that much money? One way to measure the economic value of any medical or surgical procedure is to calculate the cost per quality-adjusted life year (cost/QALY) gained. Proving cost-effectiveness is necessary in order to justify payment for these procedures -- especially for patients on Medicare. Here's what cost per quality of life year (cost/QALY) really means. The actual cost of the procedure for your cousin was $20,000. But if the procedure works and he is pain free and able to return to work and regular daily activities, then there is a clinical benefit of the procedure each year following the surgery. That value can be measured in dollars and cents. If there are no additional surgeries or added costs, then even a high-cost procedure like cervical spine fusion can gain even more value over time. And any surgical procedure that gains between $50,000 and $100,000 is considered "worth it" (cost-effective). In a recent study, surgeons calculated the cost/QALY for neck fusion (ACDF) over a five-year period. There were 352 men and women between the ages of 22 and 73 years old in the study. They each had a single-level instrumented anterior cervical discectomy and fusion (ACDF) procedure. Instrumented means that hardware such as metal plates and screws were used. Bone graft material was also used to help create a solid spinal fusion. After analyzing all the data for these 352 patients (including direct costs for additional medical procedures for complications), they found the cost/QALY gained in the first year was $106,000. That figure meets the cost-effective criteria. In the next four years, there was a continued added benefit though it wasn't as high as the first year. For example, in the second year after the surgery, the cost/QALY gained was $54,000. In the third year, it was $38,800 and in the fourth and fifth years, it was between $24,000 (fourth year) and $29,000 (third year). The conclusion of the study was that single-level neck fusion using the instrumented anterior cervical discectomy and fusion (ACDF) approach has lasting clinical benefit. The five-year favorable cost/QALY provided evidence that the ACDF is cost-effective and durable. In other words, the gains in health benefit are maintained over time adding value with each additional year without problems. About 18% of the group needed follow-up care. The types of additional surgeries needed by some patients included implant removal, fusion revision, adding a posterior fusion, and removing hematomas (pocket of blood collected in the surgical area). The cost of these procedures was calculated as $20,000 per patient. But even with these added costs, the value added was greater than the additional costs, so the ACDF procedure was still considered cost-effective. Leah Y. Carreon, MD, MSc, et al. Cost-Effectiveness of Single-Level Anterior Cervical Discectomy and Fusion Five Years After Surgery. In Spine. March 15, 2013. Vol. 38. No. 6. Pp. 471-475.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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