Houston Methodist. Leading Medicine

Neck FAQ

Question:

Can you explain the idea of cost for quality of life after surgery? When I balked at paying $15,000 for a neck fusion, the surgeon told me I would gain up to $100,000 in quality of life afterwards. How does that work? Where does the money come from?

Answer:

One way to measure the economic value of any surgical (or medical) procedure is to calculate the cost per quality-adjusted life year (cost/QALY) gained. It sounds like this is the concept your surgeon was referring to. 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 is the $15,000. But if the procedure works and you are pain free and able to return to work and/or 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). You don't actually receive that money in hard cold cash. In a recent study, surgeons calculated the cost/QALY over a five-year period for 352 patients who 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 provides 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. 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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