Economic and Outcomes Analysis of Recalcitrant Cervical Radiculopathy: Is Nonsurgical Management or Surgery More Cost-Effective?

Abstract

Introduction: This study directly compares the economical and clinical effectiveness of the use of cervical epidural injections and continued physical therapy versus surgical management in cases of cervical radiculopathy that have failed 6 weeks of conservative management.

Methods: A theoretical cohort of patients with cervical radiculopathy resistant to 6 weeks of noninvasive conservative management were simulated to treatment with either anterior cervical diskectomy and fusion (ACDF) or cervical epidural injections and continued physical therapy and analyzed with Markov chain decision tree Monte Carlo simulation.

Results: The average incremental cost-effectiveness ratio associated with ACDF was $6,768 per quality-adjusted life year over the lifetime of the patient, whereas the incremental cost-effectiveness ratio associated with cervical injections ranged from $9,033 to $4,044 per quality-adjusted life year based on the success rate.

Discussion: Our study suggests that for the management of recalcitrant cervical radiculopathy, ACDF remains the dominant strategy compared with cervical epidural injections if the surgical avoidance rate of such injections is less than 50%. If there is a greater than 50% surgery avoidance rate with injections, then cervical epidural injections would be considered a cost-effective strategy with a role in the management of cervical radiculopathy before surgery.