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骨质疏松性椎体骨折椎体增强的成本效益和意愿支付阈值,它们基于什么:系统评价。

Cost-effectiveness and willing-to-pay thresholds for vertebral augmentation of osteoporotic vertebral fractures, what are they based on: a systematic review.

机构信息

Dalla Lana School of Public Health, Institute Health Policy Evaluation and Management, University of Toronto, Toronto, Ontario, Canada

Department Medical Imaging, University Health Network, Toronto, Ontario, Canada.

出版信息

BMJ Open. 2023 Jul 25;13(7):e062832. doi: 10.1136/bmjopen-2022-062832.

Abstract

OBJECTIVE

Although there is substantial clinical evidence on the safety and effectiveness of vertebral augmentation for osteoporotic vertebral fractures, cost-effectiveness is less well known. The objective of this study is to provide a systematic review of cost-effectiveness studies and policy-based willingness-to-pay (WTP) thresholds for different vertebral augmentation (VA) procedures, vertebroplasty (VP) and balloon kyphoplasty (BK), for osteoporotic vertebral fractures (OVFs).

DESIGN

A systematic review targeting cost-effectiveness studies of VA procedures for OVFs.

DATA SOURCES

Six bibliographic databases were searched from inception up to May 2021.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Studies were eligible if meeting all predefined criteria: (1) VP or BK intervention, (2) OVFs and (3) cost-effectiveness study. Articles not written in English, abstracts, editorials, reviews and those reporting only cost data were excluded.

DATA EXTRACTION AND SYNTHESIS

Information was extracted on study characteristics, cost-effective estimates, summary decisions and payer WTP thresholds. Incremental cost-effective ratio (ICER) was the main outcome measure. Studies were summarised by a structured narrative synthesis organised by comparisons with conservative management (CM). Two independent reviewers assessed the quality (risk of bias) of the systematic review and cost-effectiveness studies by peer-reviewed checklists.

RESULTS

We identified 520 references through database searching and 501 were excluded as ineligible by titles and abstract. Ten reports were identified as eligible from 19 full-text reviews. ICER for VP versus CM evaluated as cost per quality-adjusted life-year (QALY) ranged from €22 685 (*US$33 395) in Netherlands to £-2240 (*US$-3273), a cost-saving in the UK. ICERs for BK versus CM ranged from £2706 (*US$3954) in UK to kr600 000 (*US$90 910) in Sweden. ICERs were within payer WTP thresholds for a QALY based on historical benchmarks.

CONCLUSIONS

Both VP and BK were judged cost-effective alternatives to CM for OVFs in economic studies and were within WTP thresholds in multiple healthcare settings.

摘要

目的

尽管有大量临床证据表明椎体强化术治疗骨质疏松性椎体骨折的安全性和有效性,但成本效益的情况却知之甚少。本研究旨在对不同椎体强化(VA)程序(经皮椎体成形术(VP)和球囊椎体后凸成形术(BK))治疗骨质疏松性椎体骨折(OVF)的成本效益研究和基于政策的支付意愿(WTP)阈值进行系统综述。

设计

针对 OVF 的 VA 程序的成本效益研究进行系统综述。

数据来源

从创建到 2021 年 5 月,共检索了 6 个文献数据库。

入选标准

符合所有预设标准的研究符合入选条件:(1)VP 或 BK 干预,(2)OVF 和(3)成本效益研究。不使用英文撰写的文章、摘要、社论、评论以及仅报告成本数据的文章均被排除在外。

数据提取和综合

提取了研究特征、成本效益估计、总结决策和支付方 WTP 阈值的信息。增量成本效益比(ICER)是主要的观察指标。研究通过与保守治疗(CM)进行比较的结构化叙述性综合进行总结。两名独立的审查员通过同行评审清单评估了系统综述和成本效益研究的质量(偏倚风险)。

结果

通过数据库搜索共确定了 520 条参考文献,通过标题和摘要排除了 501 条不相关的参考文献。从 19 篇全文综述中确定了 10 份符合条件的报告。VP 与 CM 相比的 ICER 作为每质量调整生命年(QALY)的成本,从荷兰的€22685(*33395 美元)到英国的-2240(*3273 美元),成本节约。BK 与 CM 相比的 ICER 从英国的£2706(*3954 美元)到瑞典的 kr600000(*90910 美元)。基于历史基准,在多个医疗保健环境中,ICER 均符合支付方的 WTP 阈值。

结论

在经济研究中,VP 和 BK 均被认为是 OVF 的 CM 的有效替代方案,并且在多个医疗保健环境中均符合 WTP 阈值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9b6/10373718/94dec4127034/bmjopen-2022-062832f01.jpg

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