Cost-Effectiveness Analysis of Cervical Laminoplasty According to the Severity of Cervical Myelopathy

Cervical laminoplasty is widely used for multilevel degenerative cervical myelopathy. However, despite its broad clinical application, evidence evaluating its cost-effectiveness in terms of quality-adjusted life years (QALYs) remains limited. In addition, little is known about whether the economic value of laminoplasty differs according to the severity of preoperative myelopathy. This study aimed to evaluate the cost-effectiveness of cervical laminoplasty and to determine whether cost-effectiveness varies across severity groups.

We retrospectively reviewed 116 consecutive patients who underwent cervical laminoplasty for degenerative multilevel cervical stenosis between 2017 and 2022 with a minimum follow-up of 24 months. Patient-reported outcomes (PROs), including the Numeric Rating Scale for neck pain (NRS-neck), Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scores, and Euro Quality of Life-5 Dimension (EQ-5D) index value, were collected at baseline and at 3, 6, 12, and 24 months postoperatively. Two-year QALYs were calculated using the EQ-5D index values. Direct and indirect medical costs were obtained from billing records and converted to 2025 US dollars ($). Missing preoperative mJOA scores were addressed using multiple imputation. Patients were stratified into mild, moderate, and severe myelopathy groups based on imputed mJOA scores.

The mean total costs per patient were $5,612.9, and a Cost/QALY gain of $29,604.6. All PROs demonstrated significant improvement at 24 months compared with baseline (P < .05). Total costs did not differ among mild, moderate, and severe myelopathy groups (P = .950). However, QALY gains differed significantly (P < .001), with median values of 0.022, 0.052, and 0.397 for mild, moderate, and severe myelopathy, respectively. Patients with severe disease demonstrated significantly higher utility gains than those with mild or moderate disease (adjusted P < .001), whereas no significant difference was observed between the mild and moderate groups (adjusted P = .521).

Cervical laminoplasty was associated with clinical improvement in degenerative cervical myelopathy. Patients with more severe preoperative myelopathy achieved greater QALY gains despite similar costs.