A cost-consequence analysis comparing spinal fusion and decompression with decompression alone in the treatment of degenerative spondylolisthesis
Notice bibliographique
Résumé
Aims: The aim of this study was to compare outcomes of combined fusion and decompression with decompression alone in patients with lumbar degenerative sponylolisthesis. Traditional cost-effectiveness analysis was avoided due to the prospective nature of the two groups of patients. Methods: A cost-consequence analysis using prospective, multicentred, observational cohort data from the Canadian Spine Outcomes and Research Network database was performed from a limited societal perspective. The patients' out-of-pocket expenses were estimated from diaries. Institutional costs were estimated from case costing data from the site with greatest enrolment. Cost-effectiveness was not assessed. Instead, the outcomes and costs associated with each form of treatment are presented independently. The Oswestry Disability Index (ODI), quality-adjusted life years (QALYs) from EuroQol five-dimension questionnaire (EQ-5D-5L), and the 12-Item Short-Form Health Survey questionnaire (SF-12) were recorded as the health outcomes. The potential effects of confounding variables on outcomes were controlled using augmented inverse probability of treatment weighting. Results: There were a total of 332 patients: 248 (75%) had a fusion and decompression and 84 (25%) underwent decompression alone, between August 2015 and February 2020. There were no statistically significant differences in ODI, SF-12, and QALY scores in either the unadjusted or the adjusted models at two years between the two groups, although the baseline patient-reported outcome measures (PROMs) were significantly worse for those who underwent fusion and decompression. Fusion and decompression (CAD$13,534) was more costly compared with decompression alone ($6,540) at year one. The overall revision rate was increased in those who underwent fusion and decompression (9%) compared with decompression alone (4%). Conclusion: Fusion and decompression was more costly than decompression alone. The PROMs were similar postoperatively in the two groups despite differences at baseline. Thus, fusion and decompression for most patients with lumbar degenerative sponylolisthesis would seem not to be justified financially, and future work is required to determine the baseline characteristics of the patients which would justify the increased costs.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».