Department of Orthopaedics Surgery, west china hospital, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan.
J Orthop Surg Res. 2024 Nov 14;19(1):755. doi: 10.1186/s13018-024-05231-8.
This study aimed to compare the efficacy and cost-utility of unilateral biportal endoscopy (UBE) versus percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of single-level lumbar disc herniation (LDH).
A retrospective analysis was conducted on 99 patients who underwent either UBE (n = 33) or PEID (n = 66) between July 2022 and December 2023 at the Second Xiangya Hospital. Patients were matched 1:2 based on age, sex, and surgery level to ensure comparability. Clinical outcomes were assessed using Visual Analog Scale (VAS), European Quality of Life-5 Dimensions (EQ-5D), and Oswestry Disability Index (ODI) scores, with quality-adjusted life years (QALYs) calculated for cost-utility analysis. Hospitalization costs were analyzed, and the incremental cost-utility ratio (ICER) was determined.
Both UBE and PEID groups demonstrated significant postoperative improvements in VAS, EQ-5D, and ODI scores (p < 0.05). The operative time, blood loss and nursing cost were significantly higher for UBE compared to PEID (p < 0.05). UBE has higher gained QALY and overall costs, but the differences are not statistically significant (p = 0.643 for QALY, p = 0.327 for costs). The Incremental Cost-Effectiveness Ratio (ICER) for UBE compared to PEID was calculated to be $354.5 per QALY gained, indicating that for each additional QALY gained through UBE, an additional cost of $354.5 is incurred compared to PEID.
In our single-center study conducted in China, both the UBE and PEID procedures have demonstrated comparable short-term efficacy in alleviating pain and improving functional ability in patients with single-level LDH. UBE procedure demonstrates greater cost-utility than the PEID procedure in cost-utility analysis, despite its longer operative time, higher nursing costs and greater blood loss.
本研究旨在比较单侧双通道内镜（UBE）与经皮内镜椎间孔入路椎间盘切除术（PEID）治疗单节段腰椎间盘突出症（LDH）的疗效和成本效用。
回顾性分析了 2022 年 7 月至 2023 年 12 月在第二湘雅医院接受 UBE（n=33）或 PEID（n=66）治疗的 99 例患者。基于年龄、性别和手术水平，采用 1:2 匹配方法以确保可比性。使用视觉模拟评分（VAS）、欧洲生活质量-5 维度（EQ-5D）和 Oswestry 残疾指数（ODI）评分评估临床结果，并计算质量调整生命年（QALYs）进行成本效用分析。分析住院费用，并确定增量成本效用比（ICER）。
UBE 和 PEID 组术后 VAS、EQ-5D 和 ODI 评分均显著改善（p<0.05）。UBE 组的手术时间、出血量和护理费用明显高于 PEID 组（p<0.05）。UBE 具有更高的获得 QALY 和总费用，但差异无统计学意义（QALY 方面 p=0.643，费用方面 p=0.327）。与 PEID 相比，UBE 的增量成本效果比（ICER）为每获得 1 个 QALY 增加 354.5 美元，这意味着与 PEID 相比，通过 UBE 获得每额外 1 个 QALY 需要额外增加 354.5 美元的成本。
在我们在中国进行的单中心研究中，UBE 和 PEID 两种手术在缓解单节段 LDH 患者疼痛和改善功能能力方面均显示出短期疗效相当。尽管 UBE 手术的手术时间较长、护理成本较高且出血量较大，但在成本效用分析中，UBE 手术的成本效用优于 PEID 手术。
