臨床整形外科53巻1号

2018年01月発行

論述

腰椎変性疾患に対するinstrumentationを併用したPLIFの費用効用分析—一般的尺度と疾患特異的尺度を用いた検討

著者： 藤原啓恭¹ 小田剛紀¹ 島田裕子² 森口悠¹ 米延策雄³ 牧野孝洋⁴ 海渡貴司⁴

所属機関： ¹国立病院機構大阪南医療センター整形外科 ²国立病院機構大阪南医療センター事務部企画課診療情報管理 ³大阪行岡医療大学 ⁴大阪大学大学院医学系研究科器官制御外科学(整形外科)

ページ範囲：P.43 - P.50

背景：「公的医療費支払者」の立場から後方経路腰椎椎体間固定術(PLIF)の費用効用分析を行うこと．

対象と方法：1椎間のPLIFを施行した50例の出来高換算入院時全診療報酬(Cost)を調査した．質調整生存年(QALY)導出に必要なQOL効用値として一般的尺度にShort-Form 6 dimention(SF-6D)，疾患特異的尺度にRoland-Morris Disability Questionnaire(RDQ)を使用し，術後2年まで経過観察し，その費用効用比(Cost/QALY)を算出した．

結果：SF-6Dからみた術後2年でのQALY獲得値は0.226，Cost/QALYは1020万7261円，RDQからみた術後2年でのQALY獲得値は0.497，Cost/QALYは464万1531円であった．

まとめ：わが国の費用効用分析はいまだ不足しており，整形外科のみならず各分野でのエビデンスの蓄積が急務である．

参考文献

1) 鎌江伊三夫，林　良造，城山英明(監)．医療技術の経済評価と公共政策．海外の事例と日本の針路．東京：じほう；2013．

2) 海渡貴司．質調整生存年　QALY-Quality-Adjusted Life Year．臨整外　2016；52：68-70．

3) Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine (Phila Pa 1976) 1983;18:2106-7.

4) Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. Ⅰ. Indications, operative technique, after care. J Neurosurg 1953;10:154-68.

5) Steffee AD, Biscup RS, Sitkowski DJ. Segmental spine plates with pedicle screw fixation. A new internal fixation device for disorders of the lumbar and thoracolumbar spine. Clin Orthop Relat Res 1986;203:45-53.

6) Okuda S, Miyauchi A, Oda T, et al. Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine 2006;4:304-9.

7) 泉田重雄，井上駿一．腰痛治療成績判定基準．日整会誌　1986；60：391-4．

8) Fukui M, Chiba K, Kawakami M, et al. Subcommittee of the Clinical Outcome Committee of the Japanese Orthopaedic Association on Low Back Pain and Cervical Myelopathy Evaluation:JOA Back Pain Evaluation Questionnaire (JOABPEQ)/JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The report on the development of revised versions. April 16, 2007. The Subcommittee of the Clinical Outcome Committee of Japanese Orthopaedic Association on Low Back Pain and Cervical Myelopathy Evaluation. J Orthop Sci 2009;14:348-65.

9) Roland M, Morris R. A study of the natural history of back pain. PartⅠ:development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 1983;8:141-4.

10) Roland M, Morris R. A study of natural history of low-back pain. PartⅡ:development of guidelines for traials of treatment in primary care. Spine (Phila Pa 1976) 1983;8:145-50.

11) Suzukamo Y, Fukuhara S, Kikuchi S, et al. Validation of the Japanese Version of the Roland-Morris Disability Questionnaire. J Orthop Sci 2003;8:543-8.

12) 福原俊一(編著)．RDQ日本語版マニュアル：腰痛特異的QOL尺度．医療文化社，東京，2004．

13) Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002;21:271-92.

14) Brazier J, Fukuhara S, Roberts J, et al. Estimating a preference-based index from the Japanese SF-36. J Clin Epidemiol 2009;24:1085-8.

15) 日本整形外科学会/日本脊椎脊髄病学会診断評価等基準委員会．JOABPEQ，JOACMEQマニュアル．東京：南江堂；2012．p.25-9．

16) Tan GH, Goss BG, Thorpe PJ, et al. CT-based classification of long spinal allograft fusion. Eur Spine J 2007;16:1875-81.

17) Kind P. Quality of Life and Pharmacoeconomics in Clinical Trials, 2nd ed. Philadelphia:Lippincott-Raven, 1996.

18) Fairbank JC, Couper J, Davies JB, et al. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271-3.

19) Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000;25:2940-52.

20) Johnsen LG, Hellum C, Nygaard ØP, et al. Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC Musculoskelet Disord 2013;14:148.

21) Fayers PM, Aaronson N, Bjordal K, et al. The EORTC QLQ-C30 Scoring Manual. Denmark 3rd ed. Brussels:European Organisation for Research and Treatment of Cancer;2001.

22) Juniper EF, Guyatt GH, Ferrie PJ, et al. Measuring quality of life in asthma. Am Rev Respir Dis 1993;147:832-8.

23) Elmallah RK, Chughtai M, Khlopas A, et al. Determining cost-effectiveness of total hip and knee arthroplasty using the Short Form-6D utility measure. J Arthroplasty 2017;32:351-4.

24) Glassman SD, Polly DW, Dimar JR, et al. The cost effectiveness of single-level instrumented posterolateral lumbar fusion at 5 years after surgery. Spine (Phila Pa 1976) 2012;37:769-74.

25) Fehlings MG, Jha NK, Hewson SM, et al. Is surgery for cervical spondylotic myelopathy cost-effective? A cost-utility analysis based on data from the AOSpine North America prospective CSM study. J Neurosurg Spine 2012;17:89-93.

26) Guide to the Methods of Technology Appraisal, 2013. London, National Institute for Clinical Excellence.

27) Burnett MG, Stein SC, Bartels RH. Cost-effectiveness of current treatment strategies for lumbar spinal stenosis:nonsurgical care, laminectomy, and X-STOP. J Neurosurg Spine 2010;13:39-46.

28) Shiroiwa T, Sung YK, Fukuda T, et al. International survey on willingness-to-pay (WTP) for one additional QALY gained:what is the threshold of cost effectiveness? Health Economics 2010;19:422-37.

29) McCarthy I, O'Brien M, Ames C, et al. Incremental cost-effectiveness of adult spinal deformity surgery:observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery. Nuerosurg Focus 2014;36:E3.

30) Parker SL, Mendenhall SK, Shau DN, et al. Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis:comparative effectiveness and cost-utility analysis. World Neurosurg 2014;82:230-8.

31) Gandhoke GS, Shin HM, Chang YF, et al. A cost-effectiveness comparison between open transforaminal and minimally invasive lateral lumbar interbody fusions using the incremental cost effectiveness ratio at 2-year follow-up. Neurosurgery 2016;78:585-95.

32) 山口英敏，金村徳相，佐竹宏太郎・他．腰椎変性すべり症に対するXLIFとPPSを用いた固定術による間接的除圧効果の検討．J Spine Res 2015；6：829-34．