Value-Utility Evaluation of Pedicle Screw Elimination After Profitable Posterior Instrumented Fusion in Thoracolumbar Burst Fractures.
Backbone (Phila Pa 1976). 2017 Aug 01;42(15):E926-E932
Authors: Lee HD, Jeon CH, Chung NS, Search engine marketing YW
STUDY DESIGN: A price-utility evaluation (CUA).
OBJECTIVE: The goal of this examine was to find out the cost-effectiveness of pedicle screw elimination after posterior fusion in thoracolumbar burst fractures.
SUMMARY OF BACKGROUND DATA: Pedicle screw instrumentation is a regular fixation methodology for unstable thoracolumbar burst fracture. Nonetheless, elimination of the pedicle screw after profitable fusion stays controversial as a result of the scientific advantages stay unclear. CUA might help clinicians make applicable selections about optimum well being take care of pedicle screw elimination after profitable fusion in thoracolumbar burst fractures.
METHODS: We performed a single-center, retrospective, longitudinal matched-cohort examine of prospectively collected outcomes. In whole, 88 consecutive sufferers who had undergone pedicle screw instrumentation for thoracolumbar burst fracture with profitable fusion confirmed by computed tomography (CT) had been used on this examine. In whole, 45 sufferers needed to bear implant elimination surgical procedure (R group), and 43 determined to not take away the implant (NR group). A CUA was performed from the well being care perspective. The direct prices of well being care had been obtained from the medical invoice of every affected person. Adjustments in health-related high quality of life (HRQoL) scores, validated by Quick Kind 6D, had been used to calculate quality-adjusted life-years (QALYs). Complete prices and gained QALY had been calculated at 1 yr (1 yr) and a couple of years (2 years) in contrast with baseline. Outcomes are expressed as an incremental cost-effectiveness ratio (ICER). Totally different low cost charges (zero%, three%, and 5%) had been utilized to each value and QALY for sensitivity evaluation.
RESULTS: Baseline affected person variables had been comparable between the 2 teams (all P?>?zero.05). The extra advantages of implant elimination (zero.201 QALY at 2 years) had been achieved with further prices ($2541 at 2 years), equating to an ICER of $12,641/QALY. On the idea of the totally different low cost charges, the robustness of our examine’s outcomes was additionally decided.
CONCLUSION: Implant elimination after profitable fusion in a thoracolumbar burst fracture is cost-effective till postoperative yr 2.
LEVEL OF EVIDENCE: three.
PMID: 27879575 [PubMed – indexed for MEDLINE]