Establishing the Socio-Economic Impact of Degenerative Cervical Myelopathy Is Fundamental to Improving Outcomes [AO Spine RECODE-DCM Research Priority Number 8]

Abstract

Study design: Literature Review (Narrative).

Objective: To contextualize AO Spine RECODE-DCM research priority number 5: What is the socio-economic impact of DCM? (The financial impact of living with DCM to the individual, their supporters, and society as a whole).

Methods: In this review, we introduce the methodology of health-economic investigation, including potential techniques and approaches. We summarize the current health-economic evidence within DCM, so far focused on surgical treatment. We also cover the first national estimate, in partnership with Myelopathy.org from the United Kingdom, of the cost of DCM to society. We then demonstrate the significance of this question to advancing care and outcomes in the field.

Results: DCM is a common and often disabling condition, with a significant lack of recognition. While evidence demonstrates the cost-effectives of surgery, even among higher income countries, health inequalities exist. Further the prevalent residual disability in myelopathy, despite treatment affects both the individual and society as a whole. A report from the United Kingdom provides the first cost-estimate to their society; an annual cost of ∼£681.6 million per year, but this is likely a significant underestimate.

Conclusion: A clear quantification of the impact of DCM is needed to raise the profile of a common and disabling condition. Current evidence suggests this is likely to be globally substantial.

Keywords: cervical myelopathy; cervical spondylosis; cervical stenosis; degeneration; disc herniation; health economics; ossification posterior longitudinal ligament; policy; research priorities; socioeconomics.

Figure 1.

Summary of types of health economic analysis, including their principal purpose (represented as Output) and data requirements (represented as Input).

Figure 2.

Estimate of overall annual cost to society, United Kingdom (myelopathy.org, United Kingdom). Total costs are round to nearest £100 000. In 2018, there were 4218 admissions, at an average cost of £9216 per admission: total cost of admission £38 900 000. Of these admissions, 2264 were within working age (defined as between 18 and 65), with an average 15.1 years remaining before retirement. Based on Pope et al up to 45% (1019) could be unable to return to work. The weighted annual average salary for 2018 is £25 524. For those of working age, lifetime loss of productivity is £362.6m. The weighted average disability payment (2020) is £9021.72, which based on 16.5 years of life remaining for those of >65 years and 30.5 years (13.9+16.5) in those hospitalized with DCM at the average age of 51.1 years, gives a total annual cost of £280.2m.