Cost-benefit analysis: intraoperative neurophysiological monitoring in spinal surgeries.
Cost-benefit analysis: intraoperative neurophysiological monitoring in spinal surgeries.
复制标题
成本效益分析：脊柱手术中的术中神经生理学监测。
DOI：
10.1097/wnp.0b013e3182933d8f
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Watanabe,JonH
中科院分区：
文献类型：
--
作者：
Ney,JohnP;vanderGoes,DavidN;Watanabe,JonH
目的：建立脊柱手术术中神经生理监测的成本-效益模型。方法：决策模型基于敏感性、特异性、IOM成本、IOM警报的预防率和脊柱手术神经系统并发症发生率，这些数据来自已发表文献的汇总估计，包括神经监测与未监测脊柱手术后的终身成本。神经损伤的终生成本是直接医疗保健费用和损失的工资和福利的总和。对蒙特卡罗模拟的10,000次重复结果进行了成本结果和输入变量与结果的关系分析。结果：IOM为50岁的参考病例节省了23,189美元（P< 0.001），神经系统并发症发生率为5%，2009年IOM的医疗报销为每次手术1,535美元，给予IOM警报的预防率为52.4%，敏感性为94.3%，特异性为95.6%，假设不完全性（非瘫痪性）运动损伤。手术的基线风险、神经功能缺损后的终生成本以及IOM警报后预防神经功能缺损的能力与成本结果最相关。在线性预测模型中，当手术神经并发症发生率超过0.3%（P< 0.001）和IOM警报后的预防率大于14.2%（P= 0.02）时，IOM仍然节省成本。结论：根据目前已发表的文献，在理论模型中，术中监测可以节省脊柱手术的成本。
Purpose:To construct a cost–benefit model for intraoperative neurophysiological monitoring (IOM) in spinal surgeries.Methods:Decision model was based on sensitivity, specificity, IOM cost, prevention rate given an IOM alert, and spinal procedure neurologic complication rates in pooled estimates from the published literature with outcome of lifetime costs after neuromonitored versus unmonitored spinal surgeries. Lifetime cost of neurologic injury was the sum of direct health care costs and lost wages and benefits. Results from Monte Carlo simulation with 10,000 replications were analyzed for cost outcomes and relationship of input variables to outcomes.Results:IOM saved $23,189 (P< 0.001) for the reference case of 50-year-olds with neurologic complication rate of 5%, 2009 Medicare reimbursement of IOM at $1,535 per operation, 52.4% prevention rate given an IOM alert at 94.3% sensitivity and 95.6% specificity, assuming incomplete (nonplegic) motor injury. The baseline risk of surgery, lifetime costs after neurologic deficit, and ability to prevent neurologic deficits after an IOM alert were most correlated with cost outcomes. In linear prediction models, IOM remained cost-saving when neurologic complication rate from surgery exceeded 0.3%(P< 0.001) and prevention rate after IOM alert was greater than 14.2%(P= 0.02).Conclusions:Intraoperative monitoring is cost-saving for spinal surgeries in a theoretical model based on the current published literature.