Coflex棘突间动力重建术与360°融合术治疗单节段腰椎退变性疾病的成本-效用分析  

Coflex Interspinous Dynamic Reconstruction and 360° Fusion for Single Level Lumbar Degenerative Disease:A Cost-utility Analysis

作　　者：刘进[1] 刘浩[1] 李涛[1] 曾建成[1] 宋跃明[1] 刘立岷[1] 龚全[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国循证医学杂志》2011年第8期893-898,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的从卫生经济学角度对Coex棘突间动力重建术与360°融合术治疗单节段腰椎退变性疾病进行成本-效用分析,为临床医生及单节段腰椎退变性疾病患者选择最佳治疗方案提供参考。方法对2008年10月至2010年11月期间,四川大学华西医院骨科采用后路减压联合Coex棘突间动力重建术(A组)与椎间及后外侧360°植骨融合术(B组)治疗的腰4～5节段退变性疾病患者进行前瞻性非随机对照研究,以SF-36量表调查患者生活质量并计算质量调整生命年(QALY),同时收集治疗成本,比较两组的成本-效用比。结果共纳入60例患者,其中A组29例,B组31例,平均随访16.4(12～23)月。其中A组男20例,女9例,年龄45.1(21～67)岁;B组男16例,女15例,年龄56.2(32～86)岁。A、B组医疗成本分别为51509.9±2422.9元、57409.7±9072.9元,生活质量分别较术前改善42.60%、42.82%,成本效用比分别为69165.6±4716.0元/QALY、77976.7±12757.4元/QALY,A组每提高一个QAlY较B组可节约12.74%的成本。结论 Coex棘突间动力重建术与360°融合术治疗单节段腰椎退变性疾病短期疗效相当,但比后者治疗成本低,更符合卫生经济学要求。Objective From the viewpoint of health economics,to analyse the cost-utility of Coflex interspinous dynamic reconstruction and 360°fusion in the treatment of single level lumbar degenerative disease,so as to provide references to doctors and patients for making the best solution.Methods From October 2008 to November 2010,a prospective non-randomized controlled study was carried out on the patients diagnosed as L4-L5 degenerative lumbar spinal disorders,of whom Group A were treated by posterior decompression combined with Coflex interspinous dynamic reconstruction and Group B accepted lumbar 360°fusion treatment.The SF-36 questionnaire was used to survey the life quality of patients and to calculate the quality-adjusted life year（QALY）;meanwhile,the costs of the treatment were collected to compare the cost-utility ratio between the two groups.Results A total of 60 patients were included,among whom 29 patients including 20 males and 9 females were in Group A,and the other 31 patients including 16 males and 15 females were in Group B;and the mean time of follow-up was 16.4 months（12-23 months）.The average age of Group A and Group B was 45.1 years（21-67 years） and 56.2 years（32-86 years）,respectively;the medical costs were 51 509.9±2 422.9 yuan and 57 409.7±9 072.9 yuan,respectively;the life quality compared with that of pre-operation improved by 42.60% and 42.82%,respectively;the cost-utility ratios were 69165.6±4716.0 yuan/QALY and 77 976.7±12 757.4 yuan/QALY,respectively.For each increase of one QALY,Group A could save 12.74% of the cost compared with Group B.Conclusion Coflex interspinous dynamic reconstruction has the equal short-term effects to lumbar 360° fusion in the treatment of L4-L5 degenerative lumbar spinal disorders,but it has lower costs than the latter,and is more in line with the requirements of health economics.

关 键 词：Coex 动力重建 后路椎体间融合 360°融合 成本-效用分析 卫生经济学 

分 类 号：R687.3[医药卫生—骨科学]