腰椎间盘突出症手术量增加与成本效益分析：一项全国性队列研究。
Increased Volume of Lumbar Surgeries for Herniated Intervertebral Disc Disease and Cost-Effectiveness Analysis: A Nationwide Cohort Study.
机构信息
Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
Spine (Phila Pa 1976). 2018 Apr 15;43(8):585-593. doi: 10.1097/BRS.0000000000002473.
STUDY DESIGN
Retrospective cohort study of a nationwide database.
OBJECTIVE
The primary objective was to summarize the use of surgical methods for lumbar herniated intervertebral disc disease (HIVD) at two different time periods under the national health insurance system. The secondary objective was to perform a cost-effectiveness analysis by utilizing incremental cost-effectiveness ratio (ICER).
SUMMARY OF BACKGROUND DATA
The selection of surgical method for HIVD may or may not be consistent with cost effectiveness under national health insurance system, but this issue has rarely been analyzed.
METHODS
The data of all patients who underwent surgeries for HIVD in 2003 (n = 17,997) and 2008 (n = 38,264) were retrieved. The surgical methods included open discectomy (OD), fusion surgery, laminectomy, and percutaneous endoscopic lumbar discectomy (PELD). The hospitals were classified as tertiary-referral hospitals (≥300 beds), medium-sized hospitals (30-300 beds), or clinics (<30 beds). ICER showed the difference in the mean total cost per 1% decrease in the reoperation probability among surgical methods. The total cost included the costs of the index surgery and the reoperation.
RESULTS
In 2008, the number of surgeries increased by 2.13-fold. The number of hospitals increased by 34.75% (731 in 2003 and 985 in 2008). The proportion of medium-sized hospitals increased from 62.79% to 70.86%, but the proportion of surgeries performed at those hospitals increased from 61.31% to 85.08%. The probability of reoperation was highest after laminectomy (10.77%), followed by OD (10.50%), PELD (9.20%), and fusion surgery (7.56%). The ICERs indicated that PELD was a cost-effective surgical method. The proportion of OD increased from 71.21% to 84.12%, but that of PELD decreased from 16.68% to 4.57%.
CONCLUSION
The choice of surgical method might not always be consistent with cost-effectiveness strategies, and a high proportion of medium-sized hospitals may be responsible for this change.
LEVEL OF EVIDENCE
研究设计
全国数据库的回顾性队列研究。
目的
主要目的是总结在国家健康保险制度下，两个不同时期腰椎间盘突出症（HIVD）的手术方法的使用情况。次要目的是通过利用增量成本效益比（ICER）进行成本效益分析。
背景资料概要
HIVD 手术方法的选择可能符合或不符合国家健康保险制度的成本效益，但这个问题很少被分析。
方法
检索了 2003 年（n=17997）和 2008 年（n=38264）接受 HIVD 手术的所有患者的数据。手术方法包括开放式椎间盘切除术（OD）、融合手术、椎板切除术和经皮内镜腰椎间盘切除术（PELD）。医院分为三级转诊医院（≥300 张病床）、中型医院（30-300 张病床）和诊所（＜30 张病床）。ICER 显示了手术方法之间每降低 1%再手术概率的平均总费用差异。总费用包括索引手术和再手术的费用。
结果
2008 年手术数量增加了 2.13 倍。医院数量增加了 34.75%（2003 年为 731 家，2008 年为 985 家）。中型医院的比例从 62.79%增加到 70.86%，但这些医院的手术比例从 61.31%增加到 85.08%。椎板切除术的再手术概率最高（10.77%），其次是 OD（10.50%）、PELD（9.20%）和融合手术（7.56%）。ICER 表明 PELD 是一种具有成本效益的手术方法。OD 的比例从 71.21%增加到 84.12%，但 PELD 的比例从 16.68%减少到 4.57%。
结论
手术方法的选择可能并不总是符合成本效益策略，而中型医院比例的增加可能是造成这种变化的原因。
证据水平
4 级。
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