| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 93 === Purpose
From a point of view of the third-party payers, this study hopes to look for the most acceptable intervertebral fusion procedure in terms of costs and effectiveness after anterior cervical discectomy. This fusion procedure should fit cost-effective analysis. Moreover, the other attempt is to establish an analytic model which could be applied to the comparison of different therapeutic strategies.
Methods
This investigation retrospectively analyzed one hundred and three consecutive cases who received one-level cervical discectomy and fusion procedures for radiculopathy and/or myelopathy between April 1995 and April 2004. According to the fusion materials and procedures, patients were classified into four groups, namely group I autograft only, group II autograft plus plate system, group III biocompatible osteoconductive polymer (BOP) only and group IV carbon fiber cage plus plate system. ANOVA (Analysis of Variance), multiple regression and logistic regression were used to analyse the estimated costs and outcomes. Three variables were used to evaluate the outcome. They were length of hospital stay (LOS), decrease of disc height (collapse of disc space) and bone fusion rate. In order to compute a multi-attribute index based on outcome variables, we first ranked the groups according to their performance in two variables, disc height preservation rate and bone fusion rate. Then, a summation of these two ranks was used to determine which fusion procedure was the best. The cost-effectiveness in fusion procedures also was evaluated.
Results
In terms of total hospitalization cost, including operative cost, anesthesia cost and post-operative hospitalization cost, group IV was the highest, followed by group II, group III, and group I was the lowest. As for outcomes, group IV had the shortest LOS and group I had the longest LOS (P < 0.01). Group II and group IV were the best two groups in maintenance of disc height after operations (P < 0.001). Group III’s bone fusion rate was the lowest (P < 0.001). Complications which needed to receive operation again during follow-up period only happened in cases of group I and group III. The summation of all the ranks in disc preservation rate and bone fusion rate revealed that group I autograft only was the best one to demonstrate the most cost-effectiveness option of the procedures in our study.
Conclusions
Besides choosing the most cost-effective fusion procedure, this model of multi-attribute cost-effectiveness analysis could be further used in other therapeutic protocols to provide a good decision making process for patients, doctors and the third-party payers.
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