5 年时磁驱动生长棒治疗早发性脊柱侧凸的成本分析。
Cost Analysis of Magnet-driven Growing Rods for Early-onset Scoliosis at 5 Years.
机构信息
Golden Jubilee National Hospital, Clydebank, Scotland.
Royal National Orthopaedic Hospital, Stanmore, England.
出版信息
Spine (Phila Pa 1976). 2019 Jan 1;44(1):60-67. doi: 10.1097/BRS.0000000000002738.
STUDY DESIGN
Prospective case series of nine children with early-onset scoliosis (EOS) treated by a single surgeon with a novel implant, the magnet-driven growing rod (MdGR) in a publicly funded health care service accounting for "payer costs" (PC) incurred.
OBJECTIVE
The aim of this study was to compare the cost-effectiveness of MdGR versus conventional growing rods (CGRs) with respect to the PC incurred for treating EOS at 5 years.
SUMMARY OF BACKGROUND DATA
Cost estimate and mathematical modeling study projections of MdGR have shown despite high insertional costs, it breaks even with CGR by 3 to 4 years. However, no clinical study to date exists either supporting or refuting this hypothesis.
METHODS
Nine patients with EOS secondary to idiopathic (two), congenital (one), syndromic (three), and neuromuscular (three) etiologies treated by submuscular insertion of MdGR against stringent inclusion criteria formed the study cohort. We collected costs incurred with all aspects of care over the lifetime of device (or at least 5 years) from payers' perspective to compute and report average PC incurred per patient. We performed this cost analysis by comparing the MdGR PC against literature reported PC for CGR at 5 years.
RESULTS
There were five single rod (SR) and two dual rod (DR) de novo MdGR insertions, while two patients had conversion of CGR to MdGR. MdGR alone accounted for at least 50% of overall budget. The MdGR was at least 40% more cost-effective in comparison to the CGR (£34,741 vs. £52,293) and there were seven MdGR graduates.
CONCLUSION
The first study reporting direct PC incurred in EOS treated by MdGR that is devoid of any mathematical modeling and deterministic sensitivity analysis is presented. The true societal/human cost savings taking into consideration indirect costs are likely to be significantly higher. MdGR is a promising novel implant that may eventually become the "standard of care" for certain EOS etiologies.
LEVEL OF EVIDENCE
研究设计
对 9 名由同一位外科医生使用新型植入物（磁驱动生长棒，MdGR）治疗的早发性脊柱侧凸（EOS）患儿进行前瞻性病例系列研究，这些患儿均在公共资助的医疗保健服务中接受治疗，计入“支付方成本”（PC）。
目的
本研究旨在比较 MdGR 与传统生长棒（CGR）在治疗 EOS 时 5 年的 PC 方面的成本效益。
背景数据摘要
尽管插入成本较高，但 MdGR 的成本估算和数学模型研究预测表明，它在 3 到 4 年内与 CGR 收支平衡。然而，迄今为止，尚无临床研究支持或反驳这一假设。
方法
9 名 EOS 患儿（特发性 2 例，先天性 1 例，综合征 3 例，神经肌肉性 3 例）接受了肌下插入 MdGR 的治疗，符合严格的纳入标准，形成了研究队列。我们从支付方的角度收集了设备生命周期内（或至少 5 年）所有治疗方面的成本，以计算和报告每位患者的平均 PC。我们通过将 MdGR 的 PC 与文献中报告的 5 年 CGR 的 PC 进行比较来进行成本分析。
结果
有 5 例单棒（SR）和 2 例双棒（DR）的新插入 MdGR，2 例患者将 CGR 转换为 MdGR。MdGR 单独至少占总预算的 50%。与 CGR 相比，MdGR 的成本效益至少高出 40%（34741 英镑对 52293 英镑），并且有 7 名 MdGR 毕业生。
结论
这是第一项报告由 MdGR 治疗的 EOS 直接 PC 的研究，该研究不包含任何数学建模和确定性敏感性分析。考虑到间接成本，真正的社会/人类成本节省可能会显著更高。MdGR 是一种很有前途的新型植入物，最终可能成为某些 EOS 病因的“标准治疗方法”。
证据水平
4。
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