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.