治疗椎体压缩性骨折的成本效益分析。
Cost-effectiveness analysis of treatments for vertebral compression fractures.
机构信息
Medtronic Spinal and Biologics, Sunnyvale, CA, USA.
出版信息
Appl Health Econ Health Policy. 2012 Jul 1;10(4):273-84. doi: 10.2165/11633220-000000000-00000.
BACKGROUND
Vertebral compression fractures (VCFs) can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty.
OBJECTIVE
The purpose of the present study was to characterize the cost to Medicare for treating VCF-diagnosed patients by nonsurgical management, vertebroplasty, or kyphoplasty. We hypothesized that surgical treatments for VCFs using vertebroplasty or kyphoplasty would be a cost-effective alternative to nonsurgical management for the Medicare patient population.
METHODS
Cost per life-year gained for VCF patients in the US Medicare population was compared between operated (kyphoplasty and vertebroplasty) and non-operated patients and between kyphoplasty and vertebroplasty patients, all as a function of patient age and gender. Life expectancy was estimated using a parametric Weibull survival model (adjusted for comorbidities) for 858 978 VCF patients in the 100% Medicare dataset (2005-2008). Median payer costs were identified for each treatment group for up to 3 years following VCF diagnosis, based on 67 018 VCF patients in the 5% Medicare dataset (2005-2008). A discount rate of 3% was used for the base case in the cost-effectiveness analysis, with 0% and 5% discount rates used in sensitivity analyses.
RESULTS
After accounting for the differences in median costs and using a discount rate of 3%, the cost per life-year gained for kyphoplasty and vertebroplasty patients ranged from $US1863 to $US6687 and from $US2452 to $US13 543, respectively, compared with non-operated patients. The cost per life-year gained for kyphoplasty compared with vertebroplasty ranged from -$US4878 (cost saving) to $US2763.
CONCLUSIONS
Among patients for whom surgical treatment was indicated, kyphoplasty was found to be cost effective, and perhaps even cost saving, compared with vertebroplasty. Even for the oldest patients (85 years of age and older), both interventions would be considered cost effective in terms of cost per life-year gained.
背景
椎体压缩性骨折（VCFs）可通过非手术治疗或微创外科治疗来治疗，包括椎体成形术和球囊扩张椎体后凸成形术。
目的
本研究的目的是描述非手术治疗、椎体成形术和球囊扩张椎体后凸成形术治疗 VCF 患者的医疗保险费用。我们假设对于 Medicare 患者人群，使用椎体成形术或球囊扩张椎体后凸成形术治疗 VCF 是一种比非手术治疗更具成本效益的选择。
方法
在美国 Medicare 人群中，比较了接受手术（球囊扩张椎体后凸成形术和椎体成形术）和未接受手术的 VCF 患者以及接受球囊扩张椎体后凸成形术和椎体成形术的患者之间的每例 VCF 患者获得的生命年成本，这取决于患者的年龄和性别。使用参数 Weibull 生存模型（根据合并症进行调整）估计了 100% Medicare 数据集中的 858978 例 VCF 患者的预期寿命（2005-2008 年）。根据 5% Medicare 数据集（2005-2008 年）中的 67018 例 VCF 患者，确定了每个治疗组在 VCF 诊断后 3 年内的中位数支付者成本。在成本效益分析中，基础病例使用了 3%的折扣率，敏感性分析中使用了 0%和 5%的折扣率。
结果
在考虑到中位数成本差异并使用 3%的折扣率后，与非手术治疗患者相比，球囊扩张椎体后凸成形术和椎体成形术患者的每例获得生命年成本分别为 1863 美元至 6687 美元和 2452 美元至 13543 美元。与椎体成形术相比，球囊扩张椎体后凸成形术的每例获得生命年成本范围为-4878 美元（成本节约）至 2763 美元。
结论
对于需要手术治疗的患者，与椎体成形术相比，球囊扩张椎体后凸成形术被发现具有成本效益，甚至可能具有成本节约效益。即使是最年长的患者（85 岁及以上），从获得的生命年成本来看，两种干预措施都被认为是具有成本效益的。
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