Cost-effectiveness of surgical versus conservative treatment for thoracolumbar burst fractures
| Autor: | Ebbe Stender Hansen, Efe Levent Aras, Cody Bünger, Rikke Søgaard |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Adolescent Narcotic Cost effectiveness medicine.medical_treatment Cost-Benefit Analysis Osteoporosis Lumbar vertebrae Thoracic Vertebrae Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine Medicine Humans Orthopedics and Sports Medicine Orthopedic Procedures Young adult Aged 030222 orthopedics Braces Lumbar Vertebrae business.industry Evidence-based medicine Middle Aged medicine.disease Confidence interval medicine.anatomical_structure Treatment Outcome Physical therapy Spinal Fractures Female Neurology (clinical) business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Aras, E L, Bünger, C, Hansen, ES & Søgaard, R 2016, ' Cost-effectiveness of surgical versus conservative treatment for thoracolumbar burst fractures ', Spine . https://doi.org/10.1097/BRS.0000000000001219 Aras, E L, Bunger, C, Hansen, E S & Søgaard, R 2015, ' Cost-Effectiveness of Surgical vs. Conservative Treatment for Thoracolumbar Burst Fractures ', Spine . https://doi.org/10.1097/BRS.0000000000001219 |
| DOI: | 10.1097/BRS.0000000000001219 |
| Popis: | STUDY DESIGN: Historical, register-based cohort study following 85 patients in the course of a time frame extending from two years before to two years after trauma occurrence.OBJECTIVE: To investigate the cost-effectiveness of surgery versus conservative management for thoracolumbar burst fractures.SUMMARY OF BACKGROUND DATA: Despite the prevalence of thoracolumbar burst fractures, consensus has as yet not been reached in terms of their clinical management and while from a health policy point of view, efficient use of resources is equally important, literature pertaining to this aspect is limited.METHODS: Consecutive patients who were admitted to a university clinic between 2004 and 2008 due to CT-verified AO type A3 fractures (T11-L2), age 18-65 years Patients with neurological compromise, osteoporosis, or malignancy were not included. The cost parameter defined primary- and secondary health- care use (2010-&OV0556;) and the effect parameter was based on three alternative measures of pain medication: (morphine milligram and defined daily doses (DDD) of narcotic and non-narcotic analgesics). For cost-effectiveness analysis, we employed a difference-in-difference approach, including control for treatment selection (age, gender and fracture type). Non-parametric bootstrapping was used to estimate conventional 95% confidence intervals of mean estimates.RESULTS: When taking into consideration all health care consumption, surgical management was observed to cost an additional &OV0556;10,734(4,215;15,144) as compared with conservative management. The differences on morphine at 527(-3,031;6,016) milligram, narcotic analgesics at -8(-176;127) DDD and non-narcotic analgesics at -3(-72;58) DDD were all insignificant The probability for surgery being cost-effective did not exceed 50% for any value of willingness to pay for effect.CONCLUSION: Surgical management does not seem to be a cost-effective strategy as compared with conservative management for traumatic thoracolumbar burst fractures without neurological deficits. Additional, higher-volume studies examining the clinical effect of alternative management strategies would be valuable.LEVEL OF EVIDENCE: 3. |
| Databáze: | OpenAIRE |
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