Cost-effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up.
Cost-effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up.
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DOI：
10.1007/s43390-020-00154-w
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发表时间：
2020-12
期刊：
影响因子：
1.6
通讯作者：
Bridwell KH
中科院分区：
文献类型：
--
作者：
Glassman SD;Carreon LY;Shaffrey CI;Kelly MP;Crawford CH 3rd;Yanik EL;Lurie JD;Bess RS;Baldus CR;Bridwell KH
纵向比较队列本研究的目的是使用治疗数据报告成人症状性腰椎侧弯（ASLS）手术与非手术治疗的成本效益，并与之前报告的意向治疗（ITT）进行比较分析。成人脊柱畸形是一种相对普遍的疾病，手术治疗已变得越来越普遍，但有关并发症，翻修率和成本效益的问题仍未得到解决。在这些问题中，成本效益也许是最难量化的，因为很难获得必要的数据。本研究的目的是使用实际治疗数据报告成人症状性腰椎侧凸（ASLS）手术与非手术治疗的成本效益，并与先前报告的意向治疗（ITT）分析进行比较。纳入了同一治疗组内具有至少5年随访数据的患者。每三个月收集的数据包括使用非手术方式，药物和就业状况。手术和非手术方式的费用是使用医疗保险允许费率确定的。使用红皮书确定药物费用，并根据报告的就业状况和收入计算间接费用。使用SF-6D确定质量调整生命年（QALY）。在226例患者中，195例患者（73例非手术，122例手术）符合入选标准。5年时，Op组中有29例（24%）患者接受了翻修手术，其中2例接受了2次翻修，1例接受了3次翻修。Op组的累积成本为111，451美元，累积QALY增益为2.3。非手术组的累计成本为29，124美元，累计QALY增益为0.4。这导致ICER为44，033美元，有利于Op治疗。治疗成本效益分析表明，成人腰椎侧凸的手术治疗在第3年变得有利，比之前的意向治疗分析早一年。II
Longitudinal Comparative Cohort The purpose of this study is to report on the cost-effectiveness of surgical versus nonsurgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus nonsurgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Patients with at least five-year follow-up data within the same treatment arm were included. Data collected every three months included use of nonoperative modalities, medications and employment status. Costs for surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality Adjusted Life Years (QALY) was determined using the SF-6D. Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At five years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment. This as-treated cost effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, one year earlier than suggested by a previous intent-to-treat analysis. II
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影响因子：
3.6
作者：
Hirth, RA;Chernew, ME;Weissert, WG
通讯作者：
Weissert, WG
影响因子：
2.8
作者：
Fujishiro, Takashi;Boissiere, Louis;Obeid, Ibrahim
通讯作者：
Obeid, Ibrahim
影响因子：
3
作者：
Brazier, JE;Roberts, J
通讯作者：
Roberts, J
影响因子：
3
作者：
Raman, Tina;Nayar, Suresh K.;Kebaish, Khaled M.
通讯作者：
Kebaish, Khaled M.
影响因子：
3.6
作者：
Winkelmayer, WC;Weinstein, MC;Pliskin, JS
通讯作者：
Pliskin, JS