Cost-effectiveness of Balloon Kyphoplasty for Patients With Acute/Subacute Osteoporotic Vertebral Fractures in the Super-Aging Japanese Society
Cost-effectiveness of Balloon Kyphoplasty for Patients With Acute/Subacute Osteoporotic Vertebral Fractures in the Super-Aging Japanese Society
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DOI：
10.1097/brs.0000000000002829
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发表时间：
2019-03-01
期刊：
影响因子：
3
通讯作者：
Nakamura, Hiroaki
中科院分区：
文献类型：
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作者：
Takahashi, Shinji;Hoshino, Masatoshi;Nakamura, Hiroaki
研究设计。倾向得分匹配研究。目的。本研究的目的是评估日本球囊后凸成形术 (BKP) 的成本效益。背景数据摘要。骨质疏松性椎体骨折（OVF）是老年人的常见病。在日本，2008 年疼痛性 OVF 的发病率估计为 880,000 例，大约 40% 的疼痛性 OVF 患者由于疼痛严重而住院。日本是超级老龄化社会中的领跑者，医疗费用上涨是一个经济问题。方法。分别对 116 例和 420 例急性/亚急性 OVF 进行了 BKP 和非手术治疗 (NSM)。质量调整生命年（QALY）和增量成本是根据倾向评分匹配研究计算的。使用 SF-6D 问卷评估 QALY。最后，使用马尔可夫模型，计算了 71 个匹配案例的增量成本效益比 (ICER)。结果。在 BKP 和 NSM 的比较中，患者的平均年龄分别为 78.3 岁和 77.7 岁（P = 0.456）。 BKP 手术比 NSM 多花费 402,988 日元，6 个月随访时 QALY 的增益分别为 0.153 和 0.120（差异 = 0.033）。 3 年和 20 年的 ICER 分别为 4,404,158 日元和 2,416,406 日元。根据敏感性分析，ICER 范围为 652,181 日元至 4,896,645 日元（4418-33,168 英镑）。结论。这项研究表明，在日本，BKP 是一种经济有效的 OVF 治疗选择。然而，对于年龄 > 80 岁的患者，效果可能会减弱。需要进一步的研究来阐明 BKP 在这一人群中的成本效益。
Study Design. A propensity score matching study.Objective. The aim of this study was to assess the cost-effectiveness of balloon kyphoplasty (BKP) in Japan.Summary of Background Data. Osteoporotic vertebral fracture (OVF) is a common disease in elderly people. In Japan, the incidence of painful OVF in 2008 was estimated as 880,000, and approximately 40% of patients with painful OVF are hospitalized due to the severity of pain. Japan is the front runner among super-aged societies and rising health care costs are an economic problem.Methods. BKP and nonsurgical management (NSM) for acute/subacute OVF were performed in 116 and 420 cases, respectively. Quality-adjusted life years (QALY) and incremental costs were calculated on the basis of a propensity score matching study. QALY was evaluated using the SF-6D questionnaire. Finally, using a Markov model, incremental cost-effectiveness ratios (ICERs) were calculated for 71 matched cases.Results. In the comparison between BKP and NSM, mean patients age was 78.3 and 77.7 years, respectively (P = 0.456). The BKP procedure cost 402,988 JPY more than NSM and the gains in QALY at the 6-month follow-up were 0.153 and 0.120, respectively (difference = 0.033). ICERs for 3 and 20 years were 4,404,158 JPY and 2,416,406 JPY, respectively. According to sensitivity analysis, ICERs ranged from 652,181 JPY to 4,896,645 JPY (4418-33,168 GBP).Conclusion. This study demonstrated that BKP is a cost-effective treatment option for OVF in Japan. However, the effect might be blunted in patients aged > 80 years. Further research is necessary to elucidate the cost-effectiveness of BKP in this population.