背景:在过去的十年中,磁控生长棒(MCGR)已经取代了传统的生长棒(TGR),然而,缺乏基于真实纵向数据的直接成本和治疗结果的比较.本研究旨在比较TGR和MCGR之间的直接成本和治疗结果,在合并并发症的同时,在整个治疗过程中,再次手术和健康相关生活质量(HRQoL)的变化。
方法:使用纵向数据研究了2003年至2016年在三级脊柱侧凸诊所接受初始生长棒手术的早发性脊柱侧凸(EOS)患者。累计直接医疗费用是根据每个TGR和MCGR的手术单位成本计算的,任何更换棒或术后并发症的补救手术的费用。治疗结果通过以下方式评估:使用SRS-22r问卷的患者HRQoL,和放射学参数(包括主要曲线校正,脊柱长度增益,脊髓平衡)在整个治疗过程中直至成熟。
结果:共有27例EOS患者(16例MCGR,11TGR)进行了研究。MCGR的索引手术的总直接成本为223,108港元,而TGR的较低成本为135,184港元(p<0.001)。在索引手术后2-3年,MCGR和TGR的累计总直接医疗费用变得最具可比性(TGR:MCGR比率=1.010),并且此后两组之间达到了中性。放射学参数在成熟时没有组间差异。对于HRQoL,TGR组显示出指数手术后疼痛减轻(域得分平均差异:0.53,p=0.024)和融合前自我外观更好(域得分平均差异:1.08,p=0.017)的趋势。融合/成熟时的TGR患者对治疗的满意度更高(领域评分平均差异:0.76,p=0.029)。在索引手术后2-3年,MCGR与TGR的成本和SRS-22r总分呈负相关(rs=-0.693)与TGR的正相关(rs=0.989)(p<0.05)。
结论:从索引手术到成熟,在治疗过程中,TGR对患者的治疗满意度较高,总体HRQoL与MCGR相当。因为MCGR没有显示出明显的获益,尽管两组在索引手术后2-3年的手术和成本中性.
BACKGROUND: Magnetically controlled growing rods (MCGR) have replaced traditional growing rods (
TGR) in the past decade, however, a comparison of their direct costs and treatment outcomes based on real longitudinal data is lacking. This study aims to compare the direct cost and treatment outcomes between
TGR and MCGR, whilst incorporating complications, reoperations and changes in health-related quality of life (HRQoL) throughout the entire treatment course.
METHODS: Patients with early onset scoliosis (EOS) who underwent initial growing rod surgery between 2003 and 2016 at a tertiary scoliosis clinic were studied with longitudinal data. Accumulated direct medical costs were calculated based on the unit cost of surgeries of each
TGR and MCGR, costs incurred for any rod exchange or remedial surgery for post-operative complication. Treatment outcomes were evaluated via: Patient\'s HRQoL using SRS-22r questionnaire, and radiological parameters (including major curve correction, spine length gains, spinal balance) throughout the treatment until maturity.
RESULTS: A total of 27 EOS patients (16 MCGR, 11
TGR) were studied. Total direct cost of index surgery for MCGR was HKD$223,108 versus lower cost of HKD$135,184 for
TGR (p < 0.001). At 2-3 years post-index surgery, accumulative total direct medical cost of MCGR and TGR became most comparable (TGR:MCGR ratio = 1.010) and had reached neutrality between the two groups since. Radiological parameters had no intergroup differences at maturity. For HRQoL, TGR group had shown the trend of less pain (domain score mean difference: 0.53, p = 0.024) post-index surgery and better self-appearance (domain score mean difference: 1.08, p = 0.017) before fusion. Higher satisfaction with treatment (domain score mean difference: 0.76, p = 0.029) was demonstrated by TGR patients at fusion/maturity. MCGR had negative (rs = -0.693) versus TGR\'s positive (rs = 0.989) correlations (p < 0.05) of cost and SRS-22r total scores at 2-3 years post-index surgery.
CONCLUSIONS: From index surgery to maturity, TGR demonstrated better satisfaction with treatment by patients and comparable overall HRQoL with MCGR during the treatment course, as MCGR did not show apparent benefit despite less surgeries and cost neutrality between the two groups at 2-3 years post-index surgery.