PKP与非手术治疗老年骨质疏松性椎体压缩骨折的成本-效果评价

The cost-effectiveness of percutaneous kyphoplasty vs conservative treatment for elderly osteoporsis vertebral compression fracture

中文关键词:  老年骨质疏松性椎体压缩骨折  非手术治疗  椎体后凸成形术  成本-效果评价

英文关键词:Senile osteoporsis vertebral compression fracture  Percutaneous kyphoplasty  Conservative treatment  Cost-effectiveness evaluation

中文摘要:

  【摘要】 目的：系统分析老年骨质疏松性椎体压缩骨折（OVCF）患者非手术治疗和椎体后凸成形术（PKP）治疗的成本-效果评价，为临床医师选择更适当的治疗方案提供依据。方法：选择2010年5月～2011年2月在广州市正骨医院脊柱科住院治疗的老年OVCF患者134例，根据知情同意自愿入组的原则，分为手术组67例，非手术（保守）组67例，进行成本-效果评价，即利用两组受治者住院期间、门诊随访期间及整个治疗期间临床效果指标的改善度（E）及与之相对应的所消耗的总的医疗成本（C），分别计算出单位疗效成本，即成本效果比值（C/E），然后进行组间比较；并行出院后1年时治疗费用的成本-效果评价，即在门诊发生费用，根据财务核算，得出门诊治疗的平均费用，为ΔC；根据患者住院期间ADL评价或出院后随访VAS评分，通过两个时间点的评分相差，得出临床效果指标的改善度情况，即ΔE，计算ΔC/ΔE。利用调查获得的治疗成本和去单位化计算得出的总临床疗效计算出不同治疗方案的单位疗效成本。并根据临床效果达到“完全正常”（ADL总分≤16分或VAS评分≤2分）或“功能改善”（ADL总分为17～21分或VAS评分为3～8分）的人数比例分别统计成本-效果情况。结果：以“完全正常”作为效果评价标准时，手术组成本-效果评价（C/E）为902.93，保守组为4072.56，两组间存在显著统计学差异（P＜0.05），手术组优于保守组；以“功能改善”作为效果评价标准时，手术组（C/E）为372.70，保守组为194.86，两组间存在显著统计学差异（P＜0.05），保守组成本-效果评价优于手术组。出院后治疗费用的成本-效果评价结果表明，手术组为2.88，保守组为5.63，手术组优于保守组，两组间存在显著统计学差异（P＜0.05）。结论：成本-效果分析的结果表明，如以“完全正常”为目的，PKP治疗优于非手术治疗；如仅以“功能改善”为目的，非手术治疗优于PKP治疗；在出院后治疗费用上，PKP治疗少于非手术治疗。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical effects of non operation treatment and percutaneous kyphoplasty(PKP) for elderly osteoporosis vertebral compression fracture(OVCF) and provide basic-consideration for optimum planning of operation for clinicians. Methods: 134 elderly OVCF patients were admitted into our institute, including 67 patients in operation group and 67 patients in conservative treatment who were selected from May 2010 to February 2011. All the patients were informed consent and volunteered to be in groups. Cost-effectiveness evaluation, dividing clinical effectiveness(E) by the whole cost of two groups during period of hospitalization, outpatient follow-ups and the whole treatment, was undertaken to get cost-effectiveness ratio(C/E). Compared between groups, to evaluate cost-effectiveness at 1 year after discharge(clinical cost), used the average cost(△C) of clinical treatment based on financial accounting; and obtained the situation of symptoms improvement(△E) between the scores of two time points based on ADL scores during period of hospitalization or follow-ups of VAS scores after discharge. The △C/△E was calculated. Obtaining the treating cost and unitization to get the whole clinical effect by research, which could calculate the cost of unit efficacy of different treatment methods. Cost-effectiveness of two methods were calculated according to proportion of clinical effect "complete normal"(ADL scores≤16 or VAS scores≤2) or proportion of "function improvement"(ADL scores from 17 to 21 or VAS scores from 3 to 8). Results: If "complete normal" was used as the standard of effect evaluation, the cost-effectiveness of surgical treatment group(C/E) was 902.93, the conservative group was 4072.56, PKP was superior to conservative treatment(P<0.05); If "function improvement" was used as the standard of effect evaluation, the cost-effectiveness of surgical treatment group(C/E) was 372.70, the conservative group was 194.86, conservative treatment was superior to PKP(P<0.05). The cost-effectiveness of treatment cost after discharge indicated that the surgical group was 2.88, conservative group was 5.63, PKP was superior to conservative treatment group(P<0.05). Conclusions: The result of cost-effectiveness analysis indicates that, if enhancing the quality of life was the goal, PKP was superior to conservative treatment; if the goal was "function improvement", non surgical treatment was superior to PKP; On the cost of treating cost after discharge, PKP was less than conservative treatment.