Cost-effectiveness of surgery for degenerative cervical myelopathy in the United Kingdom
Goacher, Edward Yardanov, Stefan Phillips, Richard Budu, Alexandru Dyson, Edward Ivanov, Marcel Barton, Gary Hutton, Mike Gardner, Adrian Quraishi, Nasir A
Goacher, Edward
Yardanov, Stefan
Phillips, Richard
Budu, Alexandru
Dyson, Edward
Ivanov, Marcel
Barton, Gary
Hutton, Mike
Gardner, Adrian
Quraishi, Nasir A
Affiliation
Hull University Teaching Hospitals NHS Trust; University of Cambridge; Goffin Consultancy; University Hospitals Birmingham NHS Foundation Trust; University College London Hospitals NHS Foundation Trust; Sheffield Teaching Hospitals NHS Foundation Trust; University of East Anglia; Royal Devon and Exeter NHS Foundation Trust; The Royal Orthopaedic Hospital NHS Foundation Trust; Nottingham University Hospitals NHS Trust; King's College Hospital NHS Foundation Trust; King's College London; NHS Lothian; East Suffolk and North Essex NHS Foundation Trust; St George's University Hospitals NHS Foundation Trust
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Publication date
2024-04-26
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Abstract
Purpose: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord dysfunction worldwide, for which surgery is the mainstay of treatment. At present, there is limited literature on the costs associated with the surgical management of DCM, and none from the United Kingdom (UK). This study aimed to evaluate the cost-effectiveness of DCM surgery within the National Health Service, UK.
Materials and methods: Incidence of DCM was identified from the Hospital Episode Statistics (HES) database for a single year using five ICD-10 diagnostic codes to represent DCM. Health Resource Group (HRG) data was used to estimate the mean incremental surgery (treatment) costs compared to non-surgical care, and the incremental effect (quality adjusted life year (QALY) gain) was based on data from a previous study. A cost per QALY value of <£30,000/QALY (GBP) was considered acceptable and cost-effective, as per the National Institute for Health and Clinical Excellence (NICE) guidance. A sensitivity analysis was undertaken (±5%, ±10% and ±20%) to account for variance in both the cost of admission and QALY gain.
Results: The total number of admissions for DCM in 2018 was 4,218. Mean age was 62 years, with 54% of admissions being of working age (18-65 years). The overall estimated cost of admissions for DCM was £38,871,534 for the year. The mean incremental (per patient) cost of surgical management of DCM was estimated to be £9,216 (ranged £2,358 to £9,304), with a QALY gain of 0.64, giving an estimated cost per QALY value of £14,399/QALY. Varying the QALY gain by ±20%, resulted in cost/QALY figures between £12,000 (+20%) and £17,999 (-20%).
Conclusions: Surgery is estimated to be a cost-effective treatment of DCM amongst the UK population.
Citation
Goacher E, Yardanov S, Phillips R, Budu A, Dyson E, Ivanov M, Barton G, Hutton M, Gardner A, Quraishi NA, Grahovac G, Jung J, Demetriades AK, Vergara P, Pereira E, Arzoglou V, Francis J, Trivedi R, Davies BM, Kotter MRN. Cost-effectiveness of surgery for degenerative cervical myelopathy in the United Kingdom. Br J Neurosurg. 2025 Dec;39(6):776-780. doi: 10.1080/02688697.2024.2346566. Epub 2024 Apr 26.
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Article