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Cervical Laminoplasty Versus Laminectomy and Fusion: A Comprehensive Time-driven Activity-based Cost Analysis
Theresa Chua1,2, Perry L Lim1,2, Stuart H Hershman1,2
1Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Study Design:
Retrospective study.
Objective:
To compare the true cost between posterior cervical laminectomy and fusion and cervical laminoplasty using time driven activity-based costing methodology.
Summary Of Background Data:
Cervical laminoplasty (LP) and posterior cervical laminectomy with fusion (LF) are effective procedures for treating cervical myelopathy. A comprehensive accounting of cost differences between LP versus LF is not available. Using time-driven activity-based costing (TDABC), we sought to compare the total facility costs in patients with cervical myelopathy undergoing LP versus LF.
Materials And Methods:
We conducted a retrospective analysis of 277 LP and 229 LF performed between 2019 and 2023. Total facility costs, which included personnel and supply costs, were assessed using TDABC. Separate analyses including and excluding implant costs were performed. Multiple regression analysis was utilized to assess the independent effect of LP compared with LF on facility costs, with all costs standardized using cost units (CUs).
Results:
Patients undergoing LP had lower total supply costs [672.5 vs. 765.0 CUs (0.88x), P <0.001] and lower total personnel costs [330.0 vs. 830.0 CUs (0.40x), P <0.001], resulting in a lower total facility cost both including [1003.8 vs. 1600.0 CUs (0.63x), P <0.001] and excluding implant costs [770.0 vs. 875.0 CUs (0.88x), P <0.001] (Table 1). After controlling for demographics and comorbidities, LF was associated with increased total facility costs, including (588.5 CUs, 95% CI: 517.1-659.9 CUs, P <0.001) and excluding implant costs (104.3 CUs, 95% CI: 57.6-151.0 CUs, P <0.001).
Conclusions:
Using time-driven activity-based costing, we found that total facility costs were lower in patients treated with laminoplasty. These findings suggest that laminoplasty may offer a less costly and more efficient surgical option for treating cervical myelopathy.