Aichmair A, Burgstaller J M, Schwenkglenks M, Steurer J, Porchet F, Brunner F, Farshad M
Spine Division, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
Eur Spine J. 2017 Feb;26(2):501-509. doi: 10.1007/s00586-016-4937-y. Epub 2016 Dec 31.
To evaluate the cost-effectiveness of conservative versus surgical treatment strategies for lumbar spinal stenosis (LSS).
Patients prospectively enrolled in the multicenter Lumbar Stenosis Outcome Study (LSOS) with a minimum follow-up of 12 months were included. Quality adjusted life years (QALY) were calculated based on EQ-5D data. Cost data were retrieved retrospectively. Cost-effectiveness was calculated via decision tree analysis.
A total of 434 patients were included, treated surgically (n = 170) or conservatively (n = 264) for LSS. The majority of surgically treated patients underwent decompression (n = 141, 82.9%), and 17.1% (n = 29) additionally underwent fusion. A reoperation was required in 13 (7.6%) surgically treated patients. In 27 (10.2%) conservatively treated patients, a single infiltration was successful, with no further infiltration or surgery within the follow-up. However, 46 patients (17.4%) required multiple infiltrations, and in 191 (72.4%) initially conservatively treated patients a subsequent surgery was needed. The area under the curve was 0.776 QALY in the surgical arm (0.776 and 0.790, decompression or additional fusion, respectively), compared to 0.778 in the conservative arm. Treatment costs were estimated at CHF 12,958 and 13,637 (USD 13,465 and 14,169) in surgically and initially conservatively treated patients, respectively [base-case incremental cost-effectiveness ratio (ICER): CHF 392,145, USD 407,831], per QALY gained. Probabilistic sensitivity analysis identified surgery as the preferred strategy in 67.1%.
Both the surgical and the conservative treatment approach resulted in a comparable health-related quality of life within the first year after study inclusion. Due to slightly higher costs, mostly because the majority of initially conservatively treated patients underwent multiple infiltrations or a subsequent surgery, decompressive surgery was identified as the most cost-effective approach for LSS in this setting.
评估腰椎管狭窄症（LSS）保守治疗与手术治疗策略的成本效益。
纳入前瞻性参与多中心腰椎管狭窄症结局研究（LSOS）且随访至少12个月的患者。基于EQ-5D数据计算质量调整生命年（QALY）。成本数据进行回顾性收集。通过决策树分析计算成本效益。
共纳入434例因LSS接受手术治疗（n = 170）或保守治疗（n = 264）的患者。大多数接受手术治疗的患者进行了减压手术（n = 141，82.9%），17.1%（n = 29）的患者还接受了融合手术。13例（7.6%）接受手术治疗的患者需要再次手术。在27例（10.2%）接受保守治疗的患者中，单次浸润治疗成功，随访期间未进行进一步浸润或手术。然而，46例患者（17.4%）需要多次浸润治疗，191例（72.4%）最初接受保守治疗的患者随后需要手术。手术组的曲线下面积为0.776 QALY（减压手术或额外融合手术分别为0.776和0.790），保守组为0.778。手术治疗患者和最初接受保守治疗患者的治疗成本估计分别为12,958瑞士法郎和13,637瑞士法郎（13,465美元和14,169美元）[基础病例增量成本效益比（ICER）：392,145瑞士法郎，407,831美元]，每获得1个QALY。概率敏感性分析确定手术为首选策略的比例为67.1%。
在纳入研究后的第一年，手术治疗和保守治疗方法导致的健康相关生活质量相当。由于成本略高，主要是因为大多数最初接受保守治疗的患者进行了多次浸润治疗或随后进行了手术，在这种情况下，减压手术被确定为LSS最具成本效益的方法。
