方法:本研究是对文献的系统回顾。
目的:本研究的目的是确定并介绍所有可用的研究报告用于颈椎前路椎间盘切除和融合术(ACDF)的骨生物学费用。
方法:系统回顾了文献,以确定具有特定纳入标准的研究:(1)随机对照试验和观察性研究,(2)在成人患者中,(3)椎间盘突出或退行性颈椎疾病,(4)报告在ACDF手术中使用特定骨生物制剂的直接或间接成本。(5)只包括英语学习。使用MINORS和RoB2.0工具评估纳入研究的质量。
结果:总体而言,纳入14篇文章;1项随机对照试验和13项观察性研究。除自体移植/髂骨移植(ICBG)外,最常用的骨生物制剂是同种异体移植和骨形态发生蛋白(BMP)。据报道,没有一项研究得到了行业支持。报告的成本存在相当大的异质性。总的来说,大多数研究报告了与手术相关的费用,比如麻醉,手术室,手术材料和外科医生的费用。只有两项研究,两者都使用同种异体移植,报告了所用骨生物的确切成本(450英镑,700美元)。一些研究报告了外科手术住院期间的护理费用,比如放射学研究,急诊室费用,心脏评估,实验室研究,药房费用,和房间费用。只有少数研究报告了后续行动的费用,再操作,物理治疗和康复。
结论:根据本系统综述的数据,对于在ACDF中使用骨生物制剂的成本效益,目前尚无建议.鉴于骨生物制剂的高成本,这仍然是一个重要的话题。关于这一主题的未来研究的设计应包括成本效益。
METHODS: This study constitutes a systematic
review of the literature.
OBJECTIVE: The aim of this study was to identify and present all available studies that report on the costs of osteobiologics used in anterior cervical discectomy and fusion (ACDF).
METHODS: The literature was systematically reviewed to identify studies with specific inclusion criteria: (1) randomized controlled trials and observational studies, (2) in adult patients, (3) with herniated disc(s) or degenerative cervical spine disease, (4) reporting on either direct or indirect costs of using specific osteobiologics in an ACDF operation. (5) Only studies in English were included. The quality of the included studies was assessed using the MINORS and RoB 2.0 tools.
RESULTS: Overall, 14 articles were included; one randomized controlled trial and 13 observational studies. The most commonly used
osteobiologics other than autograft/iliac crest bone graft (ICBG) were allograft and bone morphogenetic protein (BMP). None of the studies was reported to be industry-supported. There was considerable heterogeneity on the reported costs. Overall, most studies reported on surgery-related costs, such as anesthesia, operating room, surgical materials and surgeon\'s fee. Only two studies, both using allograft, reported the exact cost of the osteobiologic used (450 GBP, $700). Some of the studies reported on the cost of care during hospitalization for the surgical operation, such as radiology studies, emergency room costs, cardiologic evaluation, laboratory studies, pharmacy costs, and room costs. Only a few studies reported on the cost of follow-up, reoperation, and physical therapy and rehabilitation.
CONCLUSIONS: Based on the data of this current systematic
review, no recommendations can be made regarding the cost-effectiveness of using
osteobiologics in ACDF. Given the high costs of
osteobiologics, this remains a topic of importance. The design of future studies on the subject should include cost effectiveness.