确定与成本效益相关的疼痛、残疾和健康状况最小改善：引入最小成本效益差异的概念。

Determination of the minimum improvement in pain, disability, and health state associated with cost-effectiveness: introduction of the concept of minimum cost-effective difference.

机构信息

Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

出版信息

Neurosurgery. 2012 Dec;71(6):1149-55. doi: 10.1227/NEU.0b013e318271ebde.

DOI:10.1227/NEU.0b013e318271ebde

PMID:22986596

Abstract

BACKGROUND

Minimum clinical important difference (MCID) has been adopted as the smallest improvement in patient-reported outcome needed to achieve a level of improvement thought to be meaningful to patients.

OBJECTIVE

To use a common MCID calculation method with a cost-utility threshold anchor to introduce the concept of minimum cost-effective difference (MCED).

METHODS

Forty-five patients undergoing transforaminal lumbar interbody fusion for degenerative spondylolisthesis were included. Outcome questionnaires were administered before and 2 years after surgery. Total cost per quality-adjusted life-year (QALY) gained was calculated for each patient. MCED was determined from receiver-operating characteristic curve analysis with a cost-effective anchor of < $50,000/QALY and < $75,000/QALY. MCID was determined with the health transition item as the anchor.

RESULTS

Significant improvement was observed 2 years after transforaminal lumbar interbody fusion for all outcome measures. Mean total cost per QALY gained at 2 years was $42,854. MCED was greater than MCID for each outcome measure, meaning that a greater improvement was required to represent cost-effectiveness than a clinically meaningful improvement to patients. The area under the receiver-operating characteristic curve was consistently ≥ 0.70 with both cost-effective anchors, suggesting that outcome change scores were accurate predictors of cost-effectiveness. Mean cost per QALY gained was significantly lower for patients achieving compared with those not achieving an MCED in visual analog scale for leg pain ($43,560 vs. $112,087), visual analog scale for back pain ($41,280 vs. $129,440), Oswestry disability index ($30,954 vs. $121,750), and EuroQol 5D ($35,800 vs. $189,412).

CONCLUSION

MCED serves as the smallest improvement in an outcome instrument that is associated with a cost-effective response to surgery. With the use of cost-effective anchor of < $50,000/QALY, MCED after transforaminal lumbar interbody fusion was 4 points for visual analog scale for low back pain, 3 points for visual analog scale for leg pain, 22 points for Oswestry disability index, and 0.31 QALYs for EuroQol 5D.

摘要

背景

最小临床重要差异（MCID）已被用作患者报告结果中需要达到的最小改善程度，以实现患者认为有意义的改善水平。

目的

使用常见的 MCID 计算方法和成本-效用阈值锚定来引入最小成本效益差异（MCED）的概念。

方法

共纳入 45 例因退行性脊柱滑脱行经椎间孔腰椎体间融合术的患者。在手术前和手术后 2 年分别对患者进行了问卷调查。为每位患者计算了每获得一个质量调整生命年（QALY）的总成本。通过具有成本效益锚定<50000 美元/QALY 和<75000 美元/QALY 的成本效益接受者操作特征曲线分析来确定 MCED。使用健康转移项目作为锚定来确定 MCID。

结果

所有结果测量在经椎间孔腰椎体间融合术后 2 年均观察到显著改善。2 年时每获得一个 QALY 的平均总成本为 42854 美元。对于每个结果测量，MCED 均大于 MCID，这意味着与患者的临床意义改善相比，需要更大的改善才能具有成本效益。两种成本效益锚定的接受者操作特征曲线下面积均≥0.70，这表明结果变化得分是成本效益的准确预测指标。与未达到 MCED 的患者相比，达到 MCED 的患者在视觉模拟量表的腿部疼痛（43560 美元比 112087 美元）、视觉模拟量表的腰痛（41280 美元比 129440 美元）、Oswestry 残疾指数（30954 美元比 121750 美元）和 EuroQol 5D（35800 美元比 189412 美元）的平均成本/QALY 显著降低。