Division of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
Neurosurgical Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
World Neurosurg. 2019 May;125:e537-e543. doi: 10.1016/j.wneu.2019.01.130. Epub 2019 Feb 1.
Spinal metastases represent the most common site of bony metastases and frequently reduce quality of life. A beneficial effect of surgery and radiotherapy versus radiotherapy alone has been demonstrated in symptomatic patients. The goal of our study was to perform a cost-utility analysis of surgery for spinal metastases based on patient-level costs and health status data in a specialist spine center in Belgium.
A cost-utility analysis was performed in a prospective cohort of patients undergoing surgery for symptomatic spinal metastases in 2011-2015. EQ-5D-3L measure of health-related quality of life data were collected preoperatively and at 3, 6, 12, and 24 months. Hospital costs relating to surgical management including postoperative radiotherapy were analyzed. A retrospective cohort of patients treated with radiotherapy alone between 2011 and 2015, which matched the surgical patients for disease load and presentation, also was assessed. Quality-adjusted life years (QALYs) for nonsurgical patients were modelled against the surgical group.
In total, 38 consecutive surgical patients had information for cost-utility analysis and 8 nonsurgical patients were matched. Mean total cost in the surgical group was €16,989 (SD €8148), largely comprising nonmedical staffing cost (mean €7721, 45.9%), followed by daily operational costs (€2963, 17.6%) and medical staffing costs (€2621, 15.6%). Median initial health status was 0.33 (interquartile range 0.15-0.55), and median postoperative QALYs were 0.70 (interquartile range 0.18-1.70). Mean total cost in the nonsurgical cohort was €9354. The incremental cost-effectiveness ratio for surgical management was €13,635 (range €12,726-€14,407) per QALY.
Surgery for symptomatic spinal metastases in a specialist hospital in Belgium is cost-effective.
脊柱转移代表最常见的骨转移部位，并经常降低生活质量。手术和放疗联合治疗与单纯放疗相比，已在有症状的患者中显示出有益的效果。我们的研究目的是在比利时的一家专业脊柱中心，基于患者层面的成本和健康状况数据，对脊柱转移的手术进行成本-效用分析。
对 2011 年至 2015 年接受手术治疗的有症状脊柱转移患者进行前瞻性队列成本-效用分析。在术前和术后 3、6、12 和 24 个月收集健康相关生活质量的 EQ-5D-3L 测量数据。分析与手术管理（包括术后放疗）相关的医院成本。还评估了 2011 年至 2015 年期间接受单纯放疗治疗的回顾性队列患者，这些患者的疾病负担和表现与手术患者相匹配。对非手术患者的质量调整生命年（QALY）进行建模，与手术组进行比较。
共有 38 例连续手术患者有成本-效用分析信息，8 例非手术患者相匹配。手术组的平均总费用为 16989 欧元（标准差 8148 欧元），主要由非医疗人员成本（7721 欧元，占 45.9%）、日常运营成本（2963 欧元，占 17.6%）和医疗人员成本（2621 欧元，占 15.6%）组成。中位数初始健康状况为 0.33（四分位间距 0.15-0.55），术后中位数 QALY 为 0.70（四分位间距 0.18-1.70）。非手术组的平均总费用为 9354 欧元。手术治疗的增量成本-效果比为每 QALY 13635 欧元（范围为 12726-14407 欧元）。
在比利时的一家专业医院对有症状的脊柱转移进行手术治疗具有成本效益。
