How does accounting for worker productivity affect the measured cost-effectiveness of lumbar discectomy?
How does accounting for worker productivity affect the measured cost-effectiveness of lumbar discectomy?
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DOI：
10.1007/s11999-013-3440-6
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发表时间：
2014-04
影响因子：
4.2
通讯作者：
Schafer MF
中科院分区：
文献类型：
--
作者：
Koenig L;Dall TM;Gu Q;Saavoss J;Schafer MF
腰椎间盘突出引起的背痛是工作效率降低的一个重要原因。椎间盘突出症手术可有效减轻疼痛并改善功能。然而，很少有研究探讨手术对工人生产力的影响。我们希望确定椎间盘突出症手术对工人收入和缺勤的影响，以及如何考虑这种影响影响手术的成本效益？使用全国健康访谈调查的数据估计回归模型，以评估椎间盘突出引起的腰痛对收入和缺勤的影响。结果被纳入马尔可夫模型中，以比较与私人投保的在职患者的手术和非手术治疗相关的社会成本。临床结果和效用基于脊柱患者结果研究试验的结果和其他临床文献。我们估计手术治疗的平均年收入为 47,619 美元，非手术治疗的平均年收入为 45,694 美元。与非手术治疗相比，接受手术的患者收入增加了 1925 美元（95% CI，1121-2728 美元）。手术后，我们还估计接受手术的工人比接受非手术治疗的工人每年平均缺勤 3 天（95% CI，2.4-3.7 天）。然而，这些较少的缺勤工作日仅部分抵消了假定的手术恢复缺勤 20 个工作日。更全面地考虑椎间盘突出手术对生产力的影响，将每质量调整生命年 (QALY) 的手术成本从 4 年时间范围内的 52,416 美元降低到 35,146 美元，使用 8 年时间范围从 27,359 美元降低到 4186 美元。根据敏感性分析，根据模型假设，每个 QALY 的 4 年成本在 27,921 美元到 49,787 美元之间变化。椎间盘突出症手术带来的工人收入增加可能会抵消与手术相关的直接医疗费用的增加。在考虑到对生产力的影响后，发现椎间盘突出症手术是一种极具成本效益的手术，如果门诊和住院手术的益处分别持续超过 6 年和 12 年，则可能产生净社会节省。第二级，经济和决策分析。有关证据级别的完整描述，请参阅作者须知。
Back pain attributable to lumbar disc herniation is a substantial cause of reduced workplace productivity. Disc herniation surgery is effective in reducing pain and improving function. However, few studies have examined the effects of surgery on worker productivity. We wished to determine the effect of disc herniation surgery on workers’ earnings and missed workdays and how accounting for this effect influences the cost-effectiveness of surgery? Regression models were estimated using data from the National Health Interview Survey to assess the effects of lower back pain caused by disc herniation on earnings and missed workdays. The results were incorporated into Markov models to compare societal costs associated with surgical and nonsurgical treatments for privately insured, working patients. Clinical outcomes and utilities were based on results from the Spine Patient Outcomes Research Trial and additional clinical literature. We estimate average annual earnings of $47,619 with surgery and $45,694 with nonsurgical treatment. The increased earnings for patients receiving surgery as compared with nonsurgical treatment is equal to $1925 (95% CI, $1121–$2728). After surgery, we also estimate that workers receiving surgery miss, on average, 3 fewer days per year than if workers had received nonsurgical treatment (95% CI, 2.4–3.7 days). However, these fewer missed work days only partially offset the assumed 20 workdays missed to recover from surgery. More fully accounting for the effects of disc herniation surgery on productivity reduced the cost of surgery per quality-adjusted life year (QALY) from $52,416 to $35,146 using a 4-year time horizon and from $27,359 to $4186 using an 8-year time horizon. According to a sensitivity analysis, the 4-year cost per QALY varies between $27,921 and $49,787 depending on model assumptions. Increased worker earnings resulting from disc herniation surgery may offset the increased direct medical costs associated with surgery. After accounting for the effects on productivity, disc herniation surgery was found to be a highly cost-effective surgery and may yield net societal savings if the benefits of outpatient and inpatient surgery persist beyond 6 and 12 years, respectively. Level II, economic and decision analysis. See the Instructions for Authors for a complete description of levels of evidence.