成人腰椎侧凸手术的成本效益：来自成人症状性脊柱侧凸手术试验的实际治疗分析，随访 5 年。
Cost-effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up.
机构信息
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA.
School of Medicine Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St., 1st Floor ACB, Louisville, KY, 40202, USA.
出版信息
Spine Deform. 2020 Dec;8(6):1333-1339. doi: 10.1007/s43390-020-00154-w. Epub 2020 Jul 6.
STUDY DESIGN
Longitudinal comparative cohort.
OBJECTIVE
The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for ASLS using the as-treated data and provide a comparison to previously reported ITT analysis.
METHODS
Patients with at least 5-year follow-up data within the same treatment arm were included. Data collected every 3 months included use of nonoperative modalities, medications and employment status. Costs for surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on the reported employment status and income. Quality-Adjusted Life Years (QALY) was determined using the SF-6D.
RESULTS
Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At 5 years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment.
CONCLUSION
This as-treated cost-effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, 1 year earlier than suggested by a previous intent-to-treat analysis.
LEVEL OF EVIDENCE
II.
研究设计
纵向对比队列研究。
目的
本研究旨在报告使用实际治疗数据的成人症状性腰椎侧凸（ASLS）手术与非手术治疗的成本效益，并与先前报告的意向治疗（ITT）分析进行比较。成人脊柱畸形是一种较为常见的病症，手术治疗的应用越来越普遍，但并发症、翻修率和成本效益的相关问题仍未得到解决。在这些问题中，成本效益也许是最难量化的，因为所需的数据难以获取。本研究旨在报告使用实际治疗数据的成人症状性腰椎侧凸（ASLS）手术与非手术治疗的成本效益，并与先前报告的意向治疗（ITT）分析进行比较。
方法
纳入至少有 5 年随访数据且处于同一治疗组的患者。每 3 个月收集一次数据，包括非手术治疗方法、药物使用情况和就业状况。手术和非手术治疗方法的费用采用医疗保险可赔付费率确定。药物费用采用 RedBook 确定，间接费用根据报告的就业状况和收入计算。使用 SF-6D 确定健康调整生命年（QALY）。
结果
在 226 名患者中，195 名患者（73 名非手术组，122 名手术组）符合纳入标准。在 5 年时，手术组中有 29 名（24%）患者进行了翻修手术，其中 2 名患者进行了 2 次翻修，1 名患者进行了 3 次翻修。手术组的累计成本为 111451 美元，累计 QALY 获益为 2.3。非手术组的累计成本为 29124 美元，累计 QALY 获益为 0.4。这导致手术治疗的增量成本效益比（ICER）为 44033 美元，有利于手术治疗。
结论
本实际治疗成本效益分析表明，与先前的意向治疗分析相比，成人腰椎侧凸的手术治疗在第三年变得有利，提前了 1 年。
证据水平
II 级。
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