September 15, 2008 — 一篇新研究顯示,相較於非手術治療,標準開放式椎間盤切除手術可適度節省成本;9月1日的Spine期刊中,研究者發現手術的經濟價值有可觀的變化,根據使用的術式而有不同費用,但是依舊相對有利。
  主要研究者、Dartmouth醫學院的Anna Tosteson醫師寫道,我們使用有關資源利用、工作損失、健康相關生活品質等資料來估計每一校正生活品質-年的花費;本研究是SPORT(Spine Patient Outcomes Research Trial)試驗的一部份。
  美國神經外科學會主席James Bean醫師向Medscape Neurology & Neurosurgery表示,我對此發現並不感到驚訝;手術一開始的確比較貴,但是對於那些一開始較差的檢測,也會有重要的改善利益。
  Tosteson醫師等人發現,兩年時的每一校正生活品質-年之平均差異為0.21,手術較佳(95% CI, 0.16 – 0.25)。


一般族群,美金 (95% CI)

Medicare 健保族群,美金(95% CI)


69,403 (49,523 – 94,999)

34,355 (20,419 – 52,512)


72,181 (56,473 – 92,394)

37,285 (28,364 – 48,993)


77,300 (60,009 – 99,544)

42,111 (30,976 – 56,284)


Surgery for Intervertebral Disk Herniation Cost-Effective

By Allison Gandey
Medscape Medical News

September 15, 2008 — Standard open diskectomy is moderately cost-effective compared with nonsurgical treatment, a new study shows. Reporting in the September 1 issue of Spine, researchers found the economic value of surgery varied considerably, depending on the method used for assigning surgical costs, but remained relatively favorable.

"We used data collected on resource utilization, work loss, and health-related quality of life to estimate cost per quality-adjusted life-year gained," write the researchers, led by Anna Tosteson, ScD, from Dartmouth Medical School, in Hanover, New Hampshire. The study is part of the Spine Patient Outcomes Research Trial (SPORT).

Although surgery was more costly than nonoperative treatment, health outcomes over 2 years were better among those treated surgically.

Although surgery was more costly than nonoperative treatment, health outcomes over 2 years were better among those treated surgically, they note.

The investigators estimate the costs per quality-adjusted life-year gained with surgery compared with nonoperative treatment ranges from $34,355 to $69,403, depending on the cost of surgery.

"I'm not surprised by the findings," James Bean, MD, president of the American Association of Neurological Surgeons, told Medscape Neurology & Neurosurgery. "Surgery tends to be more expensive initially but can have important benefits even for those with worse initial health measures."

Dr. Bean says that because surgery can cost approximately two times as much as other options, physicians should consider a conservative approach.

Conservative Approach Recommended

"It is wise and proper to wait before initiating surgery," Dr. Bean said. "If the patient can improve in 4 to 6 weeks — that is the best option. But if this is not the case, and the patient continues to experience pain and is missing work and so forth, then a higher-cost option such as surgery may be worthwhile."

Investigators studied individuals from 13 spine clinics in the United States. Patients had persistent back and leg pain and a confirmed diagnosis of intervertebral disk herniation.

A total of 775 participants underwent standard open diskectomy, and 416 were treated nonoperatively. Researchers used a validated instrument (the EQ-5D) and evaluated resource utilization and indirect costs.

Dr. Tosteson and her team found the mean difference in quality-adjusted life-year gained over 2 years was 0.21 in favor of surgery (95% CI, 0.16 – 0.25).

Mean Cost per Quality-Adjusted Life-Year Gained for Surgery
Costs General Population, $ (95% CI) Medicare Population, $ (95% CI)
Total 69,403 (49,523 – 94,999) 34,355 (20,419 – 52,512)
Direct medical 72,181 (56,473 – 92,394) 37,285 (28,364 – 48,993)
Direct medical and productivity 77,300 (60,009 – 99,544) 42,111 (30,976 – 56,284)

"A strength of our economic evaluation was our ability to consider work-related productivity costs in the analysis. To understand the cost-effectiveness of surgical treatment from a societal perspective, it is important for such costs to be included," note the researchers.

"However, while we tracked self-reported work days lost because of spine-related problems, we acknowledge that more subtle productivity losses (such as less efficient work due to pain) were not measured."

The investigators also point to a number of limitations to their work, including its observational design. "We relied on patient self-reports of resource use and productivity losses to estimate total costs," they note.

The researchers also point out that due to the high degree of crossover in both the observational and randomized cohorts, they presented a pooled analysis that used longitudinal modeling to evaluate costs and outcomes of participants as they were treated.

"Although this involves complex statistical models," they note, "an advantage of this approach is that we used the experience of a large number of persons with intervertebral disk herniation whose overall characteristics did not differ statistically between cohorts."

The investigators conclude, "Our comprehensive analysis suggests that surgical treatment of herniated disk represents a reasonably cost-effective intervention when compared with other common healthcare interventions."

The researchers have disclosed no relevant financial relationships.

Spine. 2008;33:2108-2115.Abstract

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