Kumar Krishna, Hunter Gary, Demeria Denny D
Department of Surgery, Section of Neurosurgery, Regina General Hospital, University of Saskatchewan, Regina, Saskatchewan, Canada.
J Neurosurg. 2002 Oct;97(4):803-10. doi: 10.3171/jns.2002.97.4.0803.
The object of this study was to compare the cost-effectiveness of intrathecal drug therapy (IDT) with that of conventional pain therapy (CPT) in patients suffering from chronic low back pain caused by failed back syndrome. In this study, the authors tabulated actual costs, in Canadian dollars, in a consecutive series of patients undergoing IDT within the Canadian health care system and have compared them with costs in a control group in the same environment. The influence of these treatments on the quality of life (QOL) was also analyzed.
The authors report on a series of 67 patients suffering from failed back syndrome, 23 of whom underwent implantation of a programmable drug delivery pump and 44 of whom acted as controls. Patients were followed for a 5-year period during which the investigators tabulated the actual costs incurred for diagnostic imaging, professional fees, implantation costs including hardware, nursing visits for maintenance of the pumps, alternative therapies, and hospitalization costs for breakthrough pain. From this data, cumulative costs for each group were calculated for a 5-year period. Patient responses on the Oswestry Pain Questionnaire were analyzed to assess the impact of treatment on QOL. The actual cumulative costs for IDT during a 5-year period were $29,410, as opposed to $38,000 for CPT. High initial costs of equipment required for IDT were recovered by 28 months. After this time point, managing patients with CPT became the more expensive treatment option for the remainder of the follow-up period. The Oswestry Disability Index showed a 27% improvement for patients in the IDT group, compared with a 12% improvement in the control group.
In patients who respond to this treatment, IDT is cost effective in the long term despite high initial costs of implantable devices.
本研究的目的是比较鞘内药物治疗（IDT）与传统疼痛治疗（CPT）对因腰椎手术失败综合征导致的慢性下腰痛患者的成本效益。在本研究中，作者列出了加拿大医疗保健系统中接受IDT的一系列连续患者的实际成本（以加元计），并将其与相同环境下对照组的成本进行了比较。还分析了这些治疗对生活质量（QOL）的影响。
作者报告了一系列67例腰椎手术失败综合征患者，其中23例接受了可编程药物输送泵植入，44例作为对照。对患者进行了为期5年的随访，在此期间，研究人员列出了诊断成像、专业费用、包括硬件在内的植入成本、泵维护的护理访视、替代疗法以及突破性疼痛的住院成本所产生的实际费用。根据这些数据，计算了每组5年期间的累积成本。分析了患者在奥斯威斯疼痛问卷上的回答，以评估治疗对生活质量的影响。IDT在5年期间的实际累积成本为29,410加元，而CPT为38,000加元。IDT所需设备的高初始成本在28个月内得到回收。在这个时间点之后，在随访期的剩余时间里，用CPT治疗患者成为更昂贵的治疗选择。奥斯威斯残疾指数显示，IDT组患者改善了27%，而对照组改善了12%。
在对这种治疗有反应的患者中，尽管可植入设备的初始成本很高，但从长期来看，IDT具有成本效益。
