Quantify Research, Stockholm, Sweden.
LIME/MMC, Karolinska Institutet, Stockholm, Sweden.
Spine (Phila Pa 1976). 2017 Sep 1;42(17):1302-1310. doi: 10.1097/BRS.0000000000002089.
Analysis of Swedish national and regional register data.
The aim of this study was to characterize healthcare resource utilization, productivity loss, and costs of patients with low back pain (LBP) with or without leg pain, who have been referred from primary care settings to orthopedic specialist care.
Register data on outpatient and inpatient care, work absence, drug prescriptions, socioeconomics, and mortality were extracted for patients visiting orthopedic specialists for LBP in the Swedish region Västra Götaland (1.6 million inhabitants in 2015) in 2008 to 2011 (4 years).
Patients were followed with regard to resource use and costs during "LBP episodes," defined as the time period from the first visit to an orthopedic specialist ("index-point") until the last observed resource use registered with an LBP diagnosis. Patients were also followed during fixed time periods of 2 years before and 2 years after the index-point.
In total, 16,329 LBP episodes were identified (13,931 unique patients), in six diagnosis groups. Mean societal cost per LBP episode was estimated at &OV0556;6466 (SD 21,884), where indirect cost constituted 74% and half of the 26% remaining direct costs were owing to hospital inpatient care. Patients underwent surgery in 10% of the episodes (n = 1583). Cost per LBP episode varied between diagnosis groups, with a range of &OV0556;18,668 to &OV0556;40,774 in episodes with surgery and &OV0556;978 to &OV0556;10,379 in episodes without surgery. Assessment of the fixed time period of 2 years before and after index-point showed that costs increased gradually during the year before in all groups and declined the year after in all groups.
The marked decline in total costs the year after referral to an orthopaedic specialist indicates that the treatment provided, regardless of treatment, has an effect and also likely improves the quality of life for the patient.
分析瑞典国家和地区登记数据。
本研究旨在描述从初级保健机构转诊至骨科专家门诊的腰痛（LBP）伴或不伴腿痛患者的医疗资源利用、生产力损失和成本特征。
从瑞典西约特兰地区（2015 年有 160 万居民）2008 年至 2011 年（4 年）的骨科专家门诊治疗 LBP 的患者中提取了门诊和住院治疗、缺勤、药物处方、社会经济学和死亡率等方面的登记数据。
根据“腰痛发作”（定义为从第一次就诊至骨科专家就诊的时间点（“索引点”）到最后一次观察到与腰痛诊断相关的资源使用情况的时间段）期间的资源使用和成本对患者进行随访。患者还在索引点前后的 2 年固定时间段内进行随访。
共确定了 16329 例腰痛发作（13931 例患者），涉及 6 个诊断组。估计每个腰痛发作的社会总成本为 6466 瑞典克朗（SD 21884），间接成本占 74%，而 26%的剩余直接成本中有一半归因于医院住院治疗。10%的发作患者接受了手术（n=1583）。每个腰痛发作的成本在不同诊断组之间有所差异，手术组的成本范围为 18668 至 40774 瑞典克朗，非手术组的成本范围为 978 至 10379 瑞典克朗。对索引点前后 2 年的固定时间段进行评估表明，所有组在索引点前一年的成本逐渐增加，所有组在索引点后一年的成本下降。
在转诊至骨科专家后一年总成本的显著下降表明，无论治疗方法如何，所提供的治疗都有效，并且可能还会提高患者的生活质量。
4 级。
