Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP Clinical article

被引:59
作者
Burnett, Mark G. [1 ]
Stein, Sherman C. [2 ]
Bartels, Ronald H. M. A. [3 ]
机构
[1] NeuroTexas Inst, Dept Neurosurg, Austin, TX USA
[2] Univ Penn, Dept Neurosurg, Philadelphia, PA 19104 USA
[3] Radboud Univ Nijmegen, Dept Neurosurg, Med Ctr, Nijmegen, Netherlands
关键词
lumbar spine; stenosis; laminectomy; cost-effectiveness; INTERSPINAL PROCESS DECOMPRESSION; FOLLOW-UP; SURGICAL-MANAGEMENT; IMPLANT; DEVICE; CLAUDICATION; MULTICENTER; OUTCOMES; LIFE;
D O I
10.3171/2010.3.SPINE09552
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. Standard treatment options for patients with lumbar spinal stenosis include nonoperative therapies as well as decompressive laminectomy. The introduction of interspinous decompression devices such as the X-STOP has broadened treatment options, but data comparing these treatment strategies are lacking. The object of this study was to provide a cost-effectiveness analysis of laminectomy, interspinous decompression, and nonoperative treatment for patients with lumbar stenosis. Methods. The authors performed a structured literature review of lumbar stenosis and constructed a cost-effectiveness model. Using conservative treatment, decompressive laminectomy, and placement of X-STOP as the treatment arms, their primary analysis evaluated the optimal treatment strategy for a patient with lumbar stenosis at a 2-year time horizon. Secondary analyses were done to compare cases in which patients required single-level procedures with those in which multilevel procedures were required as well as to examine the outcomes for a 4-year time horizon. Outcomes were calculated using quality-adjusted life years and costs were considered from the perspective of society. Results. Laminectomy was found to be the most effective treatment strategy, followed by X-STOP and then conservative treatment at a 2-year time horizon. Both surgical procedures were more costly than conservative treatment. Because laminectomy was both more effective and less costly than X-STOP, it is said to dominate overall. When single level procedures were considered alone, laminectomy was more effective but also more costly than X-STOP. Conclusions. Lumbar laminectomy appears to be the most cost-effective treatment strategy for patients with symptomatic lumbar spinal stenosis. (DOI: 10.3171/2010.3.SPINE09552)
引用
收藏
页码:39 / 46
页数:8
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