The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT).
The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT).
复制标题
DOI：
10.1097/brs.0b013e318182e390
复制
发表时间：
2008-09-01
期刊：
影响因子：
3
通讯作者：
Weinstein JN
中科院分区：
文献类型：
--
作者：
Tosteson AN;Skinner JS;Tosteson TD;Lurie JD;Andersson GB;Berven S;Grove MR;Hanscom B;Blood EA;Weinstein JN
研究设计：脊柱患者结果研究试验观察和随机队列参与者，确诊为椎间盘突出症（IDH），接受常规非手术治疗和/或标准开放性椎间盘切除术，从基线开始，在6周、3周、6周、12周、在美国11个州的13个脊柱诊所进行了为期24个月的研究。在确诊为腰椎IDH的患者中，手术相对于非手术治疗的有效性。背景数据摘要。成本-手术作为治疗与腰部和腿部症状相关的疾病的有效性仍然知之甚少。方法：增量成本效果比，报告为基于EuroQol EQ-5D健康状态值和美国评分获得的每质量调整生命年（QALY）的折扣成本（2004美元），结果：在775例接受手术治疗的患者和416例非手术治疗的患者中，2年内的QDR平均差异为0.21（95%CI：0.16-0.25），有利于手术。手术比非手术治疗更昂贵;总费用的平均差异为14，137美元（95% CI：11，737 - 16，770美元）。手术相对于非手术治疗获得的每QALY成本为69，403美元（95%CI：49，523 - 94，999美元），使用普通成人手术成本，使用Medicare人群手术成本为34，355美元（95%CI：20，419 - 52，512美元）。手术的估计经济价值根据用于分配手术费用的方法而变化很大。
Study Design.Spine Patient Outcomes Research Trial observational and randomized cohort participants with a confirmed diagnosis of intervertebral disc herniation (IDH) who received either usual nonoperative care and/or standard open discectomy were followed from baseline at 6 weeks, 3, 6, 12, and 24 months at 13 spine clinics in 11 US states.Objective.To evaluate the cost-effectiveness of surgery relative to nonoperative care among patients with a confirmed diagnosis of lumbar IDH.Summary of Background Data.The cost-effectiveness of surgery as a treatment for conditions associated with low back and leg symptoms remains poorly understood.Methods.Incremental cost-effectiveness ratio, reported as discounted cost per quality adjusted life year (QALY) gained in 2004 US dollars based on EuroQol EQ-5D health state values with US scoring, and information on resource utilization and time away from work.Results.Among 775 patients who underwent surgery and 416 who were treated nonoperatively, the mean difference in QALYs over 2 years was 0.21 (95% CI: 0.16–0.25) in favor of surgery. Surgery was more costly than nonoperative care; the mean difference in total cost was $14,137 (95% CI: $11,737–16,770). The cost per QALY gained for surgery relative to nonoperative care was $69,403 (95% CI: $49,523–94,999) using general adult surgery costs and $34,355 (95% CI: $20,419–52,512) using Medicare population surgery costs.Conclusion.Surgery for IDH was moderately cost-effective when evaluated over 2 years. The estimated economic value of surgery varied considerably according to the method used for assigning surgical costs.