单节段颈椎退行性疾病患者的健康状态效用：前路颈椎间盘切除融合术与颈椎间盘置换术的比较。
Health state utility of patients with single-level cervical degenerative disc disease: comparison of anterior cervical discectomy and fusion with cervical disc arthroplasty.
机构信息
Department of Orthopaedic Surgery, The Mount Sinai Medical Center, New York, New York;
出版信息
J Neurosurg Spine. 2014 May;20(5):475-9. doi: 10.3171/2014.1.SPINE13718. Epub 2014 Feb 21.
OBJECT
Cost-effectiveness analysis (CEA) of medical interventions has become increasingly relevant to the discussion of optimization of care. The use of utility scales in CEA permits a quantitative assessment of effectiveness of a given intervention. There are no published utility values for degenerative disc disease (DDD) of the cervical spine, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR). The purpose of this study was to define health utility values for those health states.
METHODS
The 36-Item Short Form Health Survey data from the ProDisc-C investigational device exemption study were obtained for single-level DDD at baseline and 24 months postoperatively after ACDF or CDR procedures. Patients in the original study were randomized to either ACDF or CDR. Utilizing a commercially available Short Form-6 dimensions program, utility scores were calculated for each health state using a set of parametric preference weights obtained from a sample of the general population using the recognized valuation technique of standard gamble.
RESULTS
The baseline health state utility (HSU) value for a patient with single-level DDD was 0.54 in both the ACDF and CDR groups. Postoperative changes in HSU values were seen in both intervention groups at 24 months. Cervical disc replacement had a HSU value of 0.72. Anterior cervical discectomy and fusion was found to have a postoperative utility state of 0.71. No statistically significant difference was found in the HSU for ACDF and CDR at 24 months of follow-up.
CONCLUSIONS
This study represents the first calculated HSU value for a patient with single-level cervical DDD. Additionally, 2 common treatment interventions for this disease state were assessed. Both treatments were found to have significant impact on the HSU values. These values are integral to future CEA of ACDF and CDR.
目的
医疗干预措施的成本效益分析（CEA）越来越成为讨论优化护理的重要内容。在 CEA 中使用效用量表可以对给定干预措施的效果进行定量评估。目前尚无颈椎退行性椎间盘疾病（DDD）、前路颈椎间盘切除融合术（ACDF）或颈椎间盘置换术（CDR）的效用值发表。本研究旨在确定这些健康状况的健康效用值。
方法
从 ProDisc-C 研究的设备豁免研究中获得了 36 项简短健康调查数据，这些数据来自基线时的单节段 DDD 和 ACDF 或 CDR 手术后 24 个月。原始研究中的患者被随机分配到 ACDF 或 CDR 组。利用一种商业上可用的简短形式-6 维程序，使用从一般人群样本中获得的一套参数偏好权重，根据公认的标准赌博估值技术，为每个健康状况计算效用得分。
结果
在 ACDF 和 CDR 组中，单节段 DDD 患者的基线健康状态效用（HSU）值均为 0.54。在 24 个月时，两组患者的 HSU 值都发生了变化。颈椎间盘置换术的 HSU 值为 0.72。发现前路颈椎间盘切除术和融合术后的效用状态为 0.71。在 24 个月的随访中，ACDF 和 CDR 的 HSU 无统计学差异。
结论
本研究代表了首次为单节段颈椎 DDD 患者计算的 HSU 值。此外，还评估了这种疾病状态的 2 种常见治疗干预措施。这两种治疗方法都对 HSU 值产生了显著影响。这些值是未来 ACDF 和 CDR 的 CEA 的重要组成部分。
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