Medical Affairs Department, Kaken Pharmaceutical Co., Ltd, Tokyo, Japan.
Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.
J Med Econ. 2023 Jan-Dec;26(1):233-242. doi: 10.1080/13696998.2023.2173465.
This study aimed to analyze the cost-effectiveness of intradiscal condoliase injection compared to surgical or conservative treatment for patients with lumbar disc herniation (LDH) who are refractory to conservative treatment.
We performed the following cost-effectiveness analyses: (I) condoliase followed by open surgery (for non-responders to condoliase) vs. open surgery from the beginning, (II) condoliase followed by endoscopic surgery (for non-responders to condoliase) vs. endoscopic surgery from the beginning, and (III) condoliase + conservative treatment vs. conservative treatment. In the first two comparisons with surgical treatments, we assumed that utilities were equal in both groups and estimated the tangible (treatment, adverse events, postoperative follow-up) and intangible (mental and physical burden, and productivity loss) costs based on the existing literature, the medical expense scoring table, and online questionnaire. In the last comparison without surgical treatment, we estimated the incremental cost-effectiveness.
The average cost per patient of condoliase followed by open surgery (for non-responders to condoliase) was 701,643 yen, with a reduction of 663,369 in comparison to that of open surgery from the beginning (1,365,012 yen). The average cost per patient of condoliase followed by endoscopic surgery (for non-responders to condoliase) was 643,909 yen, with a reduction of 514,909 in comparison to that of endoscopic surgery from the beginning (1,158,817 yen). ICER was 1.58 million yen/QALY (ΔQALY = 0.119, 95% confidence interval: 0.059-0.180; Δcost = 188,809 yen at 2 years post-treatment).
Condoliase as a first line treatment option ahead of surgical treatment for LDH is superior, from a cost perspective, to surgical treatment from the beginning. Condoliase is also a cost-effective alternative to non-surgery conservative treatment.
本研究旨在分析胶原酶椎间盘内注射治疗腰椎间盘突出症（LDH）患者的成本效果，这些患者经保守治疗无效。
我们进行了以下成本效果分析：（I）胶原酶治疗后行开放手术（对胶原酶治疗无反应者）与直接行开放手术，（II）胶原酶治疗后行内镜手术（对胶原酶治疗无反应者）与直接行内镜手术，以及（III）胶原酶+保守治疗与保守治疗。在前两种与手术治疗的比较中，我们假设两组的效用相等，并根据现有文献、医疗费用评分表和在线问卷来估计有形（治疗、不良事件、术后随访）和无形（精神和身体负担以及生产力损失）成本。在后一种没有手术治疗的比较中，我们估计了增量成本效果。
胶原酶治疗后行开放手术（对胶原酶治疗无反应者）的每位患者平均成本为 701,643 日元，与直接行开放手术（1,365,012 日元）相比，成本降低了 663,369 日元。胶原酶治疗后行内镜手术（对胶原酶治疗无反应者）的每位患者平均成本为 643,909 日元，与直接行内镜手术（1,158,817 日元）相比，成本降低了 514,909 日元。ICER 为 158 万日元/QALY（ΔQALY=0.119，95%置信区间：0.059-0.180；Δ成本=188,809 日元，治疗后 2 年）。
与直接行手术治疗相比，胶原酶作为 LDH 的一线治疗选择，从成本角度来看，优于直接行手术治疗。胶原酶也是非手术保守治疗的一种具有成本效益的替代方案。
