Cost-effectiveness of Surgery for Degenerative Cervical Myelopathy in the United Kingdom.

PurposeDegenerative 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 MethodsIncidence 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 pound/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. ResultsThe 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 pound for the year. The mean incremental (per patient) cost of surgical management of DCM was estimated to be 9,216 pound (ranged 2,358 pound to 9,304) pound, with a QALY gain of 0.64, giving an estimated cost per QALY value of 14,399 pound/QALY. Varying the QALY gain by +/- 20%, resulted in cost/QALY figures between 12,000 pound (+20%) and 17,999 pound (-20%). ConclusionsSurgery is estimated to be a cost-effective treatment of DCM amongst the UK population.