Coflex棘突間動力重建術與360°融合術治療單節段腰椎退變性疾病的成本-效用分析_《中國循證醫學雜志》

作者：

劉進 ,  劉浩 , 李濤 , 曾建成 , 宋躍明 , 劉立岷 , 龔全

四川大學華西醫院骨科（成都?610041）;

關鍵詞：

Coflex 動力重建后路椎體間融合 360°融合成本-效用分析衛生經濟學

DOI：

10.7507/1672-2531.20110151

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目的　從衛生經濟學角度對Coflex棘突間動力重建術與360°融合術治療單節段腰椎退變性疾病進行成本-效用分析，為臨床醫生及單節段腰椎退變性疾病患者選擇最佳治療方案提供參考。
方法　對2008年10月至2010年11月期間，四川大學華西醫院骨科采用后路減壓聯合Coflex棘突間動力重建術（A組）與椎間及后外側360°植骨融合術（B組）治療的腰4～5節段退變性疾病患者進行前瞻性非隨機對照研究，以SF-36量表調查患者生活質量并計算質量調整生命年（QALY），同時收集治療成本，比較兩組的成本-效用比。
結果　共納入60例患者，其中A組29例，B組31例，平均隨訪16.4（12～23）月。其中A組男20例，女9例，年齡45.1（21～67）歲；B組男16例，女15例，年齡56.2（32～86）歲。A、B組醫療成本分別為51 509.9±2 422.9元、57 409.7±9 072.9元，生活質量分別較術前改善42.60%、42.82%，成本效用比分別為69 165.6±4 716.0元/QALY、77 976.7±12 757.4元/QALY，A組每提高一個QAlY較B組可節約12.74%的成本。
結論　Coflex棘突間動力重建術與360°融合術治療單節段腰椎退變性疾病短期療效相當，但比后者治療成本低，更符合衛生經濟學要求。

引用本文： 劉進,劉浩,李濤,曾建成,宋躍明,劉立岷,龔全. Coflex棘突間動力重建術與360°融合術治療單節段腰椎退變性疾病的成本-效用分析. 中國循證醫學雜志, 2011, 11(8): 893-898. doi: 10.7507/1672-2531.20110151 復制

1.	2 Walker BF, Muller R, Grant WD. Low back pain in Australian adults: the economic burden. Asia Pac J Public Health , 2003, 15(2): 79-87.
2.	WHO Scientific Group on the Burden of Musculoskeletal Conditions at the Start of the New Millennium. The burden of musculoskeletal conditions at the start of the new millennium. World Health Organ Tech Rep Ser, 2003, 919: i-x, 1-218, back cover.
3.	李魯, 王紅妹, 沈毅. SF-36健康調查量表中文版的研制及其性能測試. 中華預防醫學雜志, 2002, 36(2): 109-113.
4.	劉靜, 舒強, 王潔貞. 用SF-36 量表評價紅斑狼瘡患者生存質量. 中國公共衛生, 2004, 20(11): 1383-1384.
5.	Luis P, José AS. Problems and solutions in calculating quality-adjusted life years (QALYs). Health and Quality of Life Outcomes , 2003, 1(1): 80-87.
6.	陳民, 李孜, 何強, 等. 腎替代治療初期的成本-效用分析. 中國循證醫學雜志, 2004, 4(7): 453-459.
7.	Weinstein MC, Torrance G, McGuire A, et al . PhD3QALYs: The Basics. International Society for Pharmacoeconomics and Outcomes Research , 2009, 12(1): S5-S9.
8.	Thoma A, McKnight LL. Quality-Adjusted Life-Year as a Surgical Outcome Measure: A Primer for Plastic Surgeons. Plastic and Reconstructive Surgery , 2010, 125(4): 1279-1287.
9.	Glassman SD, Polly DW, Dimar JR, et al . The Cost Effectiveness of Single-Level Instrumented Posterolateral Lumbar Fusion at Five Years After Surgery. Spine, 2010, doi: 10.1097/BRS. 0b013e3181e 03099.
10.	Paul L, Natasja M, Schoor V. Quality of life in patients with osteoporosis. Osteoporos Int , 2005, 16: 447-455.
11.	嚴俊, 汪宏, 李天霖. 成本效用分析方法介紹. 中國慢性病預防與控制, 1994, 2(3): 111-115.
12.	Tosteson ANA, Skinner JS, Tosteson TD, et al . The Cost Effectiveness of Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation Over Two Years. Spine , 33(19): 2108-2115.
13.	Arts MP, Peul WC, Brand R, et al . Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial. BMC Musculoskeletal Disorders , 2006, 7: 42-48.
14.	Fritzell P, Hagg O, Jonsson D, et al . Cost-Effectiveness of Lumbar Fusion and Nonsurgica Treatment for Chronic Low Back Pain in the Swedish Lumbar Spine Study: A Multicenter, Randomized, Controlled Trial From the Swedish Lumbar Spine Study Group. Spine , 2004, 29(4): 421-434.
15.	Soegaard R, Bunger CE, Christiansen T, et al . Circumferential Fusion Is Dominant Over Posterolateral Fusion in a Long-term Perspective. Cost-Utility Evaluation of a Randomized Controlled Trial in Severe, Chronic Low Back Pain Spine , 2007, 32(22): 2405-2414.
16.	Freeman BJC, Steele NA, Sach TH, et al . Cost-Effectiveness of Two Forms of Circumferential Lumbar Fusion: A Prospective Randomized Controlled Trial. Spine , 2007, 32(25): 2891-2897.
17.	Kuntz KM, Snider RK, Weinstein JN, et al . Cost-Effectiveness of Fusion With and Without Instrumentation for Patients With Degenerative Spondylolisthesis and Spinal Stenosis. Spine , 2000, 25(9): 1132–1139.
18.	Burnett MG, Stein SC, Bartels RH. Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP. J Neurosurg Spine , 2010, 13(1): 39-46.
19.	Moojen WA, Arts MP, Brand R, et al . Study protocol The Felix-trial. Double-blind randomization of interspinous implant or bony decompression for treatment of spinal stenosis related intermittent neurogenic claudication. BMC Musculoskeletal Disorders , 2010, 11: 100-108.
20.	Soegaard R, Bunger CE, Christiansen T, et al . Determinants of cost-effectiveness in lumbar spinal fusion using the net bene?t framework: a 2-year follow-up study among 695 patients. Eur Spine J , 2007, 16: 1822–1831.
21.	Soegaard R, Christensen FB, Christiansen T, et al . Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain. Eur Spine J , 2007, 16: 657-668.

1. 2 Walker BF, Muller R, Grant WD. Low back pain in Australian adults: the economic burden. Asia Pac J Public Health , 2003, 15(2): 79-87.
2. WHO Scientific Group on the Burden of Musculoskeletal Conditions at the Start of the New Millennium. The burden of musculoskeletal conditions at the start of the new millennium. World Health Organ Tech Rep Ser, 2003, 919: i-x, 1-218, back cover.
3. 李魯, 王紅妹, 沈毅. SF-36健康調查量表中文版的研制及其性能測試. 中華預防醫學雜志, 2002, 36(2): 109-113.
4. 劉靜, 舒強, 王潔貞. 用SF-36 量表評價紅斑狼瘡患者生存質量. 中國公共衛生, 2004, 20(11): 1383-1384.
5. Luis P, José AS. Problems and solutions in calculating quality-adjusted life years (QALYs). Health and Quality of Life Outcomes , 2003, 1(1): 80-87.
6. 陳民, 李孜, 何強, 等. 腎替代治療初期的成本-效用分析. 中國循證醫學雜志, 2004, 4(7): 453-459.
7. Weinstein MC, Torrance G, McGuire A, et al . PhD3QALYs: The Basics. International Society for Pharmacoeconomics and Outcomes Research , 2009, 12(1): S5-S9.
8. Thoma A, McKnight LL. Quality-Adjusted Life-Year as a Surgical Outcome Measure: A Primer for Plastic Surgeons. Plastic and Reconstructive Surgery , 2010, 125(4): 1279-1287.
9. Glassman SD, Polly DW, Dimar JR, et al . The Cost Effectiveness of Single-Level Instrumented Posterolateral Lumbar Fusion at Five Years After Surgery. Spine, 2010, doi: 10.1097/BRS. 0b013e3181e 03099.
10. Paul L, Natasja M, Schoor V. Quality of life in patients with osteoporosis. Osteoporos Int , 2005, 16: 447-455.
11. 嚴俊, 汪宏, 李天霖. 成本效用分析方法介紹. 中國慢性病預防與控制, 1994, 2(3): 111-115.
12. Tosteson ANA, Skinner JS, Tosteson TD, et al . The Cost Effectiveness of Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation Over Two Years. Spine , 33(19): 2108-2115.
13. Arts MP, Peul WC, Brand R, et al . Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial. BMC Musculoskeletal Disorders , 2006, 7: 42-48.
14. Fritzell P, Hagg O, Jonsson D, et al . Cost-Effectiveness of Lumbar Fusion and Nonsurgica Treatment for Chronic Low Back Pain in the Swedish Lumbar Spine Study: A Multicenter, Randomized, Controlled Trial From the Swedish Lumbar Spine Study Group. Spine , 2004, 29(4): 421-434.
15. Soegaard R, Bunger CE, Christiansen T, et al . Circumferential Fusion Is Dominant Over Posterolateral Fusion in a Long-term Perspective. Cost-Utility Evaluation of a Randomized Controlled Trial in Severe, Chronic Low Back Pain Spine , 2007, 32(22): 2405-2414.
16. Freeman BJC, Steele NA, Sach TH, et al . Cost-Effectiveness of Two Forms of Circumferential Lumbar Fusion: A Prospective Randomized Controlled Trial. Spine , 2007, 32(25): 2891-2897.
17. Kuntz KM, Snider RK, Weinstein JN, et al . Cost-Effectiveness of Fusion With and Without Instrumentation for Patients With Degenerative Spondylolisthesis and Spinal Stenosis. Spine , 2000, 25(9): 1132–1139.
18. Burnett MG, Stein SC, Bartels RH. Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP. J Neurosurg Spine , 2010, 13(1): 39-46.
19. Moojen WA, Arts MP, Brand R, et al . Study protocol The Felix-trial. Double-blind randomization of interspinous implant or bony decompression for treatment of spinal stenosis related intermittent neurogenic claudication. BMC Musculoskeletal Disorders , 2010, 11: 100-108.
20. Soegaard R, Bunger CE, Christiansen T, et al . Determinants of cost-effectiveness in lumbar spinal fusion using the net bene?t framework: a 2-year follow-up study among 695 patients. Eur Spine J , 2007, 16: 1822–1831.
21. Soegaard R, Christensen FB, Christiansen T, et al . Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain. Eur Spine J , 2007, 16: 657-668.

《中國循證醫學雜志》

Coflex棘突間動力重建術與360°融合術治療單節段腰椎退變性疾病的成本-效用分析

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《中國循證醫學雜志》

Coflex棘突間動力重建術與360°融合術治療單節段腰椎退變性疾病的成本-效用分析

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