利用德国索赔数据对椎体后凸成形术和经皮椎体成形术的生存率及成本比较
Survival and cost comparison of kyphoplasty and percutaneous vertebroplasty using German claims data.
作者信息
Lange Ansgar, Kasperk Christian, Alvares Luisa, Sauermann Sven, Braun Sebastian
机构信息
*Leibniz University Hannover, Center for Health Economics Research Hannover, Germany †University of Heidelberg, Heidelberg, Germany ‡Spine and Biologics, Medtronic International, Tolochenaz, Switzerland §Spine and Biologics, Medtronic GmbH, Meerbusch, Germany; and ¶Herescon GmbH, Health Economic Research & Consulting, Hannover, Germany.
出版信息
Spine (Phila Pa 1976). 2014 Feb 15;39(4):318-26. doi: 10.1097/BRS.0000000000000135.
STUDY DESIGN
Observational study.
OBJECTIVE
Examine the overall survival and treatment costs from a third-party-payer perspective for patients with osteoporotic vertebral compression fractures (OVCFs) treated by vertebral augmentation or conservative treatment in Germany.
SUMMARY OF BACKGROUND DATA
OVCFs are associated with increased morbidity, mortality and thus reduced quality of life. Vertebral augmentation has been shown to be effective in these fractures. The association between treatment and survivorship as well as cost per life year gained for balloon kyphoplasty (BKP) and percutaneous vertebroplasty (PVP) was analyzed in the Medicare population. Replication of these analyses is warranted for confidence in findings.
METHODS
Claims data from a major health insurance fund were used. Mortality risk differences between operated (BKP, PVP) and nonoperated cohorts were assessed by Cox regression. Operated patient groups were established by propensity score matching adjusting for covariates. For the matched operated patients with OVCF, (2006-2010) survival was estimated by Kaplan-Meier method.
RESULTS
A total of 598 newly diagnosed patients with OVCF were operated of 3607 patients with OVCF. The operated cohort was 43% less likely to die than the nonoperated one in the 5-year study period (hazard ratio = 0.57; P < 0.001). Patients who received BKP had higher 60-month adjusted survival rate (66.7%) than those who received PVP (58.7%) (P = 0.68). Cumulative 4-year mean overall costs after first diagnosis were lower for the BKP cohort (PVP: €42,510 vs. BKP: €39,014). Initial upfront higher costs driven by surgical treatment for patients who received BKP are offset by considerable pharmacy costs in patients who received PVP. There were differences between the values of painkiller consumption (PVP: €3321 vs. BKP: €2224).
CONCLUSION
Results suggest a higher overall survival rate for operated than nonoperated patients with OVCF and indicate a potential survival benefit for patients who received BKP compared with patients who received PVP. The reasons merit further investigation. Total costs were lower after 4 years for patients who received BKP versus PVP due to less consumption of pharmaceuticals.
LEVEL OF EVIDENCE
研究设计
观察性研究。
目的
从第三方支付方的角度，研究在德国接受椎体强化或保守治疗的骨质疏松性椎体压缩骨折（OVCF）患者的总生存期和治疗费用。
背景数据总结
OVCF与发病率和死亡率增加相关，进而导致生活质量下降。椎体强化已被证明对这些骨折有效。在医疗保险人群中分析了球囊后凸成形术（BKP）和经皮椎体成形术（PVP）的治疗与生存率之间的关联以及每获得一个生命年的成本。为确保研究结果的可信度，有必要重复这些分析。
方法
使用来自一家大型健康保险基金的理赔数据。通过Cox回归评估手术治疗组（BKP、PVP）和非手术治疗组之间的死亡风险差异。通过倾向评分匹配调整协变量来建立手术治疗患者组。对于匹配的接受OVCF手术治疗的患者（2006 - 2010年），采用Kaplan - Meier方法估计生存率。
结果
在3607例OVCF患者中，共有598例新诊断患者接受了手术治疗。在5年研究期内，手术治疗组的死亡可能性比非手术治疗组低43%（风险比 = 0.57；P < 0.001）。接受BKP治疗的患者60个月调整后生存率（66.7%）高于接受PVP治疗的患者（58.7%）（P = 0.68）。首次诊断后4年的累计平均总费用，BKP治疗组较低（PVP：42,510欧元 vs. BKP：39,014欧元）。接受BKP治疗的患者因手术治疗导致的初始前期较高费用，被接受PVP治疗的患者相当高的药品费用所抵消。止痛药消费价值存在差异（PVP：3321欧元 vs. BKP：2224欧元）。
结论
结果表明，接受手术治疗的OVCF患者总生存率高于未接受手术治疗的患者，并且与接受PVP治疗的患者相比，接受BKP治疗的患者可能有生存获益。其原因值得进一步研究。由于药品消费较少，接受BKP治疗的患者4年后的总费用低于接受PVP治疗的患者。
证据级别
3级。
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