Measuring Variability and Value of Single- and Two-Level Anterior Cervical Discectomy and Fusion Using Impact Scores

Area of Science:

• Spine surgery
• Health economics
• Medical device utilization

Background:

• Intraoperative supply costs in ACDF procedures exhibit significant variability, largely influenced by implant choices.
• Current cost data is institution-specific, hindering cross-site comparisons and benchmarking.
• Impact scores offer a normalized method to assess supply cost contributions, independent of institutional pricing.

Purpose of the Study:

• To quantify intraoperative supply cost variability among surgeons and procedural levels in ACDF.
• To evaluate within-procedure value using time-driven activity-based costing (TDABC), Operative Value Index (OVI), and Unit Price per Outcome (UPO).

Main Methods:

• Retrospective analysis of 369 ACDF cases (1- and 2-level) performed by five surgeons.
• Supply items were categorized to calculate impact scores (proportional cost share).
• TDABC estimated staff costs; Neck Disability Index (NDI) and quality-adjusted life year (QALY) were used to derive OVI and UPO.

Main Results:

• Interbody devices and plates constituted the highest cost categories in both 1- and 2-level ACDF.
• Interbody implant costs significantly increased with surgical level (P<0.001).
• Biologic and interbody categories displayed the greatest inter-surgeon cost variability, with OVI and UPO varying over 2.5-fold.

Conclusions:

• Interbody devices are the primary cost drivers in ACDF, with costs escalating with additional surgical levels.
• Biologics demonstrate the most substantial variability in cost among surgeons.
• OVI and UPO provide valuable, institution-independent benchmarks for assessing procedural value.