Kuntz K M, Snider R K, Weinstein J N, Pope M H, Katz J N
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115-5924, USA.
Spine (Phila Pa 1976). 2000 May 1;25(9):1132-9. doi: 10.1097/00007632-200005010-00015.
A cost-effectiveness study was performed from the societal perspective.
To evaluate the costs and benefits of laminectomy alone and laminectomy with concomitant lumbar fusion for patients with degenerative lumbar spondylolisthesis and spinal stenosis.
Costs, probabilities, and utilities were estimated from the literature. Short-term risks considered were perioperative complications, the probability of the fusion healing, and the probability that surgery will relieve symptoms. Long-term risks considered were recurrence of symptoms and reoperation.
The 10-year costs, quality-adjusted life years, and incremental cost-effectiveness ratios (reported as dollars per quality-adjusted year of life gained) were calculated using a Markov model. Sensitivity analysis was performed on all variables using clinically plausible ranges.
Laminectomy with noninstrumented fusion costs $56,500 per quality-adjusted year of life versuslaminectomy without fusion. The cost-effectiveness of laminectomy with noninstrumented fusion was most sensitive to the increase in quality-of-life associated with relief of severe stenosis symptoms. The cost-effectiveness ratio of instrumented fusion compared with noninstrumented fusion was $3,112,800 per quality-adjusted year of life. However, if the proportion of patients experiencing symptom relief after instrumented fusion was 90% as compared with 80% for patients with noninstrumented fusion, then the cost-effectiveness ratio of instrumented fusion compared with noninstrumented fusion would be $82,400 per quality-adjusted year of life.
The cost-effectiveness of laminectomy with noninstrumented fusion compares favorably with other surgical interventions, although it depends greatly on the true effectiveness of these surgeries to alleviatesymptoms and on how patients value the quality-of-life effect of relieving severe stenosis symptoms. Instrumented fusion was very expensive compared with the incremental gain in health outcome. Better data on the effectiveness of these alternative procedures are needed.
从社会角度进行成本效益研究。
评估单纯椎板切除术以及椎板切除术联合腰椎融合术治疗退变性腰椎滑脱症和椎管狭窄症患者的成本与效益。
成本、概率和效用值依据文献进行估算。所考虑的短期风险包括围手术期并发症、融合愈合概率以及手术缓解症状的概率。所考虑的长期风险包括症状复发和再次手术。
使用马尔可夫模型计算10年成本、质量调整生命年以及增量成本效益比（以每获得一个质量调整生命年所需的美元数表示）。对所有变量在临床合理范围内进行敏感性分析。
与未行融合的椎板切除术相比，非器械辅助融合的椎板切除术每质量调整生命年花费56,500美元。非器械辅助融合的椎板切除术的成本效益对与严重狭窄症状缓解相关的生活质量提高最为敏感。与非器械辅助融合相比，器械辅助融合的成本效益比为每质量调整生命年3,112,800美元。然而，如果器械辅助融合后症状缓解的患者比例为90%，而非器械辅助融合患者为80%，那么与非器械辅助融合相比，器械辅助融合的成本效益比将为每质量调整生命年82,400美元。
非器械辅助融合的椎板切除术的成本效益与其他手术干预措施相比具有优势，尽管这在很大程度上取决于这些手术缓解症状的实际效果以及患者如何评估缓解严重狭窄症状对生活质量的影响。与健康结果的增量收益相比，器械辅助融合非常昂贵。需要关于这些替代手术有效性的更好数据。
