Department of Neurosurgery, the Leon Wiltse Memorial Hospital, Anyang, Korea.
Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo daero Secho-gu, Seoul 06591, Korea.
Spine J. 2019 Jul;19(7):1162-1169. doi: 10.1016/j.spinee.2019.02.003. Epub 2019 Feb 10.
Microdiscectomy is a standard technique for the surgical treatment of lumbar disc herniation (LDH). Endoscopic discectomy (ED) is another surgical option that has become popular owing to reports of shorter hospitalization and earlier return to work. No study has evaluated health care costs associated with lumbar discectomy techniques and compared cost-effectiveness.
To assess the cost-effectiveness of four surgical techniques for LDH: microdiscectomy (MD), transforaminal endoscopic lumbar discectomy (TELD), interlaminar endoscopic lumbar discectomy (IELD), and unilateral biportal endoscopic discectomy (UBED).
Retrospective analysis.
Patients who underwent either MD or ED for primary LDH with 1-year follow-up between the ages of 20 and 60 years old.
Incremental cost-effectiveness ratio (ICER).
Five hundred sixty-five patients aged 20-60 years who underwent treatment using one of the four surgical techniques with at least 1-year follow-up were reviewed. Health care costs were defined as the sum of direct and indirect costs. The former included the covered and uncovered costs of the National Health Insurance from operation to 1-year follow-up; indirect costs included costs incurred by work loss. Direct and indirect costs were evaluated separately. ICER was determined using cost/quality-adjusted life year (QALY). Health care costs and ICER were compared statistically among the four surgical groups. Cost-effectiveness was compared statistically between MD and ED.
One hundred fifty-seven patients who underwent TELD, 132 for IELD, 140 for UBED, and 136 for MD were enrolled. The direct costs of TELD, IELD, UBED, and MD were $3,452.2±1,211.5, $3,907.3±895.3, $4,049.2±1,134.6, and $4,302.1±1,028.9, respectively (p<.01). The indirect costs of TELD, IELD, UBED, and MD were $574.5±495.9, $587.8±488.3, $647.4±455.6, and $759.7±491.7, respectively (p<.01). The 1-year QALY gains were 0.208 for TELD, 0.211 for IELD, 0.194 for UBED, and 0.186 for MD. ICER (costs/QALY) was the highest for MD ($34,840.4±25,477.9, p<.01). Compared with MD, ED saved an additional net of $8,064 per QALY (p<.01). There was no significant difference in the ICERs among the three endoscopic techniques.
ED was more cost-effective compared with MD at 1-year follow up.
经皮内镜腰椎间盘切除术（ED）是一种治疗腰椎间盘突出症（LDH）的微创手术。由于报道称住院时间更短，恢复工作更早，该手术已成为另一种受欢迎的手术选择。 目前尚无研究评估与腰椎间盘切除术技术相关的医疗保健成本，并比较其成本效益。
评估四种用于 LDH 的手术技术的成本效益：显微椎间盘切除术（MD）、经椎间孔内镜腰椎间盘切除术（TELD）、经皮内镜腰椎间融合术（IEDL）和单侧双通道内镜椎间盘切除术（UBED）。
回顾性分析。
年龄在 20 至 60 岁之间，接受 MD 或 ED 治疗原发性 LDH 并在 1 年随访期的患者。
增量成本效益比（ICER）。
对 565 名年龄在 20-60 岁之间接受四种手术技术治疗且至少随访 1 年的患者进行了回顾性分析。医疗保健成本被定义为直接和间接成本的总和。前者包括手术至 1 年随访期间的全民健康保险的覆盖和未覆盖费用；间接成本包括因工作损失而产生的费用。分别评估直接和间接成本。使用成本/质量调整生命年（QALY）确定 ICER。对四种手术组的直接和间接成本进行统计学比较。对 MD 和 ED 之间的成本效益进行统计学比较。
共纳入 157 例接受 TELD 治疗的患者、132 例接受 IELD 治疗的患者、140 例接受 UBED 治疗的患者和 136 例接受 MD 治疗的患者。TELD、IEDL、UBED 和 MD 的直接成本分别为$3452.2±1211.5、$3907.3±895.3、$4049.2±1134.6 和$4302.1±1028.9（p<0.01）。TELD、IEDL、UBED 和 MD 的间接成本分别为$574.5±495.9、$587.8±488.3、$647.4±455.6 和$759.7±491.7（p<0.01）。TELD、IEDL、UBED 和 MD 的 1 年 QALY 获益分别为 0.208、0.211、0.194 和 0.186。MD 的 ICER（成本/QALY）最高为$34840.4±25477.9，p<0.01）。与 MD 相比，ED 每 QALY 额外节省了 8064 美元（p<0.01）。三种内镜技术的 ICER 没有显著差异。
ED 在 1 年随访时比 MD 更具成本效益。
