颈椎间盘切除融合术治疗颈椎病患者的成本-效用分析比较聚醚醚酮与三皮质髂嵴骨移植物
Cost-utility Analysis of Anterior Cervical Discectomy and Fusion for Cervical Spondylosis Patients Comparing Polyetheretherketone Versus Tricortical Iliac Crest Bone Graft.
机构信息
Division of Spine Surgery, Department of Orthopedic Surgery.
Department of Medicine, Division of Ambulatory Medicine, Mahidol University, Bangkok.
出版信息
Clin Spine Surg. 2023 Oct 1;36(8):E353-E361. doi: 10.1097/BSD.0000000000001468. Epub 2023 Jun 8.
STUDY DESIGN
Prospective cohort study.
OBJECTIVES
To perform a cost-utility analysis and to investigate the clinical outcomes and patient's quality of life after anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis compared between fusion with polyetheretherketone (PEEK) and fusion with tricortical iliac bone graft (IBG) in Thailand.
SUMMARY OF BACKGROUND DATA
ACDF is one of the standard treatments for cervical spondylosis. The fusion material options include PEEK and tricortical IBG. No previous studies have compared the cost-utility between these 2 fusion material options.
PATIENTS AND METHODS
Patients with cervical spondylosis who were scheduled for ACDF at Siriraj Hospital (Bangkok, Thailand) during 2019-2020 were prospectively enrolled. Patients were allocated to the PEEK or IBG fusion material group according to the patient's choice of fusion material. EuroQol-5 dimensions 5 levels and relevant costs were collected during the operative and postoperative periods. A cost-utility analysis was performed using a societal perspective. All costs were converted to 2020 United States dollars (USD), and a 3% discount rate was used. The outcome was expressed as the incremental cost-effectiveness ratio.
RESULTS
Thirty-six patients (18 ACDF-PEEK and 18 ACDF-IBG) were enrolled. Except for Nurick grading, there was no significant difference in patient baseline characteristics between groups. The average utility at 1 year after ACDF-PEEK and ACDF-IBG were 0.939 ± 0.061 and 0.798 ± 0.081, respectively ( P < 0.001). The total lifetime cost of ACDF-PEEK and ACDF-IBG was 83,572 USD and 73,329 USD, respectively. The incremental cost-effectiveness ratio of ACDF-PEEK when compared with that of ACDF-IBG showed a gain of 4468.52 USD/quality-adjusted life-years, which is considered cost-effective at the Thailand willingness-to-pay threshold of 5115 USD/quality-adjusted life-year gained.
CONCLUSIONS
ACDF-PEEK was found to be more cost-effective than ACDF-IBG for treating cervical spondylosis in Thailand.
LEVEL OF EVIDENCE
Level II.
研究设计
前瞻性队列研究。
目的
在泰国，比较颈椎融合术（ACDF）治疗颈椎病时使用聚醚醚酮（PEEK）融合与使用三叶髂骨移植物（IBG）融合的成本-效用分析，并调查临床结果和患者生活质量。
背景资料概要
ACDF 是颈椎病的标准治疗方法之一。融合材料的选择包括 PEEK 和三叶 IBG。以前没有研究比较这两种融合材料选择之间的成本效用。
患者和方法
2019-2020 年，在泰国诗里拉吉医院接受 ACDF 的颈椎病患者前瞻性入组。根据患者对融合材料的选择，将患者分配到 PEEK 或 IBG 融合材料组。在手术和术后期间收集 EuroQol-5 维度 5 级和相关成本。采用社会视角进行成本-效用分析。所有成本均转换为 2020 年美元（USD），并使用 3%的贴现率。结果表示为增量成本效益比。
结果
共纳入 36 例患者（ACDF-PEEK 18 例，ACDF-IBG 18 例）。除了 Nurick 分级外，两组患者的基线特征无显著差异。ACDF-PEEK 和 ACDF-IBG 后 1 年的平均效用分别为 0.939 ± 0.061 和 0.798 ± 0.081（P < 0.001）。ACDF-PEEK 和 ACDF-IBG 的终身总成本分别为 83572 美元和 73329 美元。与 ACDF-IBG 相比，ACDF-PEEK 的增量成本效益比显示增加了 4468.52 美元/质量调整生命年，这在泰国 5115 美元/质量调整生命年的支付意愿阈值下被认为是具有成本效益的。
结论
在泰国，ACDF-PEEK 治疗颈椎病比 ACDF-IBG 更具成本效益。
证据水平
2 级。
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