Dullerud R, Lie H, Magnæs B
Department of Radiology, Aker University Hospital; Center for Health Administration, The National Hospital; Oslo, Norway -
Interv Neuroradiol. 1999 Mar 30;5(1):35-42. doi: 10.1177/159101999900500106. Epub 2001 May 15.
This study was conducted in order to evaluate the cost-effectiveness of percutaneous automated lumbar nucleotomy in comparison with traditional macro-procedure discectomy in the treatment of herniated discs. Sixty-eight patients undergoing surgical procedures and 90 treated with nucleotomy were consecutively included. Both cohorts were assessed pre-operatively and at regular intervals for one year or more after treatment by independent observers, using a clinical overall scoring system (COS) with 0 being the best attainable result and 1000 the poorest conceivable status of the patients. There were better clinical results after surgery with 78% successes after one year compared to 62% after nucleotomy. By including subsequent operations and re-operations after failure to respond to the primary treatment, the success rates rose to 79% and 77%, respectively. The cost of surgical treatment was calculated to USD 6.119 per patient and the cost of a nucleotomy procedure was USD 1.252. Owing to an almost five times higher price of surgery than nucleotomy, the latter turned out to be 2.7 to 3.9 times more cost-effective, depending on whether secondary treatment was included or not. Due to the minimal difference in final outcome between the groups, however, the marginal cost per extra success in patients primarily treated with surgery was as high as USD 205.850. The study concludes that nucleotomy, as a mini-invasive procedure with low complication rates and the potential of a quick recovery, is more cost-effective than traditional surgical treatment for lumbar disc herniation.
本研究旨在评估经皮自动腰椎髓核切除术与传统开放式椎间盘切除术治疗椎间盘突出症的成本效益。连续纳入了68例接受外科手术的患者和90例接受髓核切除术的患者。两组患者在术前以及治疗后由独立观察者进行为期一年或更长时间的定期评估，采用临床综合评分系统（COS），0分为患者可达到的最佳结果，1000分为最差的可能状态。手术后临床效果更佳，一年后手术成功率为78%，而髓核切除术为62%。若将初次治疗无效后的后续手术和再次手术纳入计算，成功率分别升至79%和77%。手术治疗的成本计算为每位患者6119美元，髓核切除术的成本为1252美元。由于手术价格几乎是髓核切除术的五倍，因此髓核切除术的成本效益高出2.7至3.9倍，具体取决于是否纳入二次治疗。然而，由于两组最终结果差异极小，主要接受手术治疗的患者每多获得一次成功的边际成本高达205850美元。该研究得出结论，髓核切除术作为一种并发症发生率低且有望快速康复的微创手术，在治疗腰椎间盘突出症方面比传统手术治疗更具成本效益。
