Thaci Bart, Yee Randy, Kim Kee, Vokshoor Amir, Johnson J Patrick, Ament Jared
University of California, Davis, Sacramento, CA, USA.
Neuronomics LLC, Los Angeles, CA, USA.
Clinicoecon Outcomes Res. 2021 Jul 24;13:681-691. doi: 10.2147/CEOR.S318589. eCollection 2021.
We conducted decision analytical modeling using a Markov model to determine the ICER of i-factor compared to autograft in ACDF surgery.
The efficacy and safety of traditional anterior cervical discectomy and fusion (ACDF) surgery has improved with the introduction of new implants and compounds. Cost-effectiveness of these innovations remains an often-overlooked aspect of this effort. To evaluate the cost-effectiveness of i-FACTOR compared to autograft for patients undergoing ACDF surgery.
The patient cohort was extracted from a prospective, multicenter randomized control trial (RCT) from twenty-two North American centers. Patients randomly received either autograft (N = 154) or i-Factor (N = 165). We analyzed various real-world scenarios, including inpatient and outpatient surgical settings as well as private versus public insurances. Two primary outcome measures were assessed: cost and utility. In the base-case analysis, both health and societal system costs were evaluated. Health-related utility outcome was expressed in quality-adjusted life years (QALYs). Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER).
In all scenarios, i-FACTOR reduced costs within the first year by 1.4% to 2.1%. The savings proved to be incremental over time, increasing to 3.7% over an extrapolated 10 years. The ICER at 90 days was $13,333 per QALY and became negative ("dominated") relative to the control group within one year and onwards. In a threshold sensitivity analysis, the cost of i-FACTOR could theoretically be increased 70-fold and still remain cost-effective.
The novel i-FACTOR is not only cost-effective compared to autograft in ACDF surgery but is the dominant economic strategy.
我们使用马尔可夫模型进行决策分析建模，以确定在颈椎前路椎间盘切除融合术（ACDF）中，与自体移植相比，i-factor的增量成本效果比（ICER）。
随着新型植入物和化合物的引入，传统颈椎前路椎间盘切除融合术（ACDF）的疗效和安全性有所提高。这些创新的成本效益仍然是这项工作中经常被忽视的一个方面。评估在接受ACDF手术的患者中，与自体移植相比，i-FACTOR的成本效益。
患者队列来自北美22个中心的一项前瞻性、多中心随机对照试验（RCT）。患者随机接受自体移植（N = 154）或i-Factor（N = 165）。我们分析了各种现实世界的情况，包括住院和门诊手术环境以及私人保险与公共保险。评估了两个主要结局指标：成本和效用。在基础案例分析中，评估了健康和社会系统成本。与健康相关的效用结局以质量调整生命年（QALY）表示。成本效益以增量成本效益比（ICER）表示。
在所有情况下，i-FACTOR在第一年内将成本降低了1.4%至2.1%。随着时间的推移，节省的成本被证明是递增的，在外推的10年中增加到3.7%。90天时的ICER为每QALY 13,333美元，在一年内及之后相对于对照组变为负数（“被主导”）。在阈值敏感性分析中，i-FACTOR的成本理论上可以增加70倍，并且仍然具有成本效益。
新型i-FACTOR在ACDF手术中不仅与自体移植相比具有成本效益，而且是主要的经济策略。
