Letter to the editor regarding “Cost-effectiveness of implanting a prosthesis after anterior cervical discectomy for radiculopathy: results of the NECK randomized controlled trial” by Suasnabar et al

We have read with great interest the paper by Suasnabar et al, who conducted a study evaluating the cost utility of anterior cervical discectomy (ACD), ACD and fusion using a cage (ACDF), and anterior cervical disc arthroplasty (ACDA) in a cohort of the NECK randomized controlled trial [ [1] Heijdra Suasnabar JMH Vleggeert-Lankamp CLA Goedmakers CMW et al. Cost effectiveness of implanting a prosthesis after anterior cervical discectomy for radiculopathy: results of the neck randomized controlled trial. Spine J. 2023; 23: 851-858https://doi.org/10.1016/j.spinee.2023.02.003 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar ]. The authors demonstrated that ACDF is likely to be more cost-effective than ACDA or ACD at most willing-to-pay (WTP) thresholds. This study has the advantages of executing excellent statistical techniques and performing a sensitivity test under various WTP conditions. However, we are concerned about the following limitation: the aforementioned statistical method does not reflect the characteristics of ACDA, which has advantages in long-term follow-up [ [2] Sharma JK Varma KKK Mallepally AR et al. Two-level anterior cervical discectomy and fusion versus hybrid total disc replacement for bilevel pathology with cervical radiculopathy/myelopathy: a comparative study with a minimum 2-year follow-up in an Indian population. Asian Spine J. 2022; 16: 493-501https://doi.org/10.31616/asj.2021.0209 Crossref PubMed Scopus (4) Google Scholar ]. Hence, we question the following consideration. Reply to letter to the editor regarding “Cost-effectiveness of implanting a prosthesis after anterior cervical discectomy for radiculopathy: results of the NECK randomized controlled trial”The Spine JournalVol. 23Issue 10PreviewWe appreciate the opportunity to respond to the Letter to the Editor by Choi and Kang regarding our study on the cost-utility of implanting a prosthesis after anterior cervical discectomy [1]. The authors argue that our statistical method fails to capture the characteristics of anterior cervical discectomy with arthroplasty (ACDA), which they claim offers long-term benefits. They also contend that the advantages of ACDA are not adequately measured by the EQ-5D, the tool we used in our study to calculate quality-adjusted life-years (QALYs). Full-Text PDF