Klieverik Vita M, Robe Pierre A, Muradin Marvick S M, Woerdeman Peter A
Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Brain Spine. 2025 Feb 19;5:104217. doi: 10.1016/j.bas.2025.104217. eCollection 2025.
Autografts are considered more cost-effective than cranial implants due to the use of the patient's own bone. However, autografts are associated with a higher revision surgery rate because of their intrinsic risk of resorption. As revision surgeries imply additional hospital stays and therefore higher costs, autografts may be less cost-effective than cranial implants.
To analyze the cost-effectiveness of cranial implants compared with autografts.
We performed a retrospective cohort study of patients who underwent cranioplasty between 2014 and 2020. We collected data on the costs of cranioplasty using each patient's diagnosis and treatment combination (DBC) code. We used the incremental cost-effectiveness ratio (ICER) to assess cost-effectiveness, which was calculated as the ratio of incremental cost and incremental effect of using a cranial implant instead of an autograft.
A total of 168 patients were included (mean age 43.0 ± 20.0 years). The median cost of the first cranioplasty procedure was €6249.37 (IQR €5250.64 - €8551.36) for cranial implants and €6261.36 (IQR €5189.14 - €7792.10) for autografts (p = 0.094). The median total cost of all health care related to the cranioplasty procedure was €6460.64 (IQR €6039.68 - €9533.03) for cranial implants and €12,075.01 (IQR €6409.63 - €16,420.71) for autografts (p < 0.001). The ICER of cranial implants compared with autografts was -€7663.22 per revision surgery avoided.
This study found that the use of cranial implants is at a lower cost and more clinically effective than the use of autologous bone grafts.
由于使用患者自身的骨骼，自体骨移植被认为比颅骨植入物更具成本效益。然而，由于自体骨移植存在内在的吸收风险，其翻修手术率较高。由于翻修手术意味着额外的住院时间，因此成本更高，自体骨移植的成本效益可能低于颅骨植入物。
分析颅骨植入物与自体骨移植相比的成本效益。
我们对2014年至2020年间接受颅骨成形术的患者进行了一项回顾性队列研究。我们使用每位患者的诊断和治疗组合（DBC）代码收集颅骨成形术的成本数据。我们使用增量成本效益比（ICER）来评估成本效益，其计算方法是使用颅骨植入物而非自体骨移植的增量成本与增量效果之比。
共纳入168例患者（平均年龄43.0±20.0岁）。首次颅骨成形术的中位成本，颅骨植入物为6249.37欧元（四分位间距5250.64欧元 - 8551.36欧元），自体骨移植为6261.36欧元（四分位间距5189.14欧元 - 7792.10欧元）（p = 0.094）。与颅骨成形术相关的所有医疗保健的中位总成本，颅骨植入物为6460.64欧元（四分位间距6039.68欧元 - 9533.03欧元），自体骨移植为12075.01欧元（四分位间距6409.63欧元 - 16420.71欧元）（p < 0.001）。与自体骨移植相比，颅骨植入物的ICER为每避免一次翻修手术7663.22欧元。
本研究发现，使用颅骨植入物比使用自体骨移植成本更低且临床效果更佳。
