腰椎椎間盤突出患者不同治療方式之成本效果分析

Abstract

研究目的: 腰椎椎間盤突出是很常見的問題，造成許多病患疼痛不堪且影響日常生活功能，傳統的復健治療方式，雖能改善症狀，卻須花費相當大的金錢及時間成本，國外推行另一種侵入性的治療方式「脊髓硬膜外腔類固醇注射」，國內尚未被廣泛接受，故想藉此研究比較這種治療方式和一般傳統復健，是否能快速地得到效果，且成本效果是否也在合理範圍之內。 研究方法: 將主診斷為腰椎椎間盤突出併神經根壓迫的病患分成二組，分別為實驗組接受脊髓硬膜外腔類固醇注射加傳統復健，對照組則只接受傳統復健治療，二組皆以住院方式接受治療，各評估其治療前、治療一週後及治療一個月後追蹤的效果指標，包括背痛指數降低、腿痛指數降低、失能百分比及憂鬱指數的變化，以比較二組的治療效果；再比較各組治療費用，擷取復健治療費用、藥費及注射技術費來做二組的成本效果分析。 研究結果: 實驗組「脊髓注射加傳統復健」及對照組「只接受傳統復健」在治療一週及一個月後都比治療前有顯著的改善，除了對照組一個月後的憂鬱指數沒有顯著差異，表示二種方式都有效果，再比較二組的組間差異，可得四項效果指標中，實驗組皆優於對照組，且在背痛指數降低及失能百分比減少，二組具顯著差異；成本效果分析方面，實驗組的治療費用雖高於對照組，但若以ICER(△C/△E)的方法去比較，則可得實驗組「脊髓注射加傳統復健」有較佳的成本效果。 結論 雖然「脊髓外腔類固醇注射」用於治療椎間盤突出病患，目前在國內尚不普及，且治療費用較高，但在本研究中若以短期效果來看，在傳統復健加入此侵入性療法，可得較顯著的背痛減輕及功能提升的效果。

Purpose： Herniation of intervertebral disc (HIVD) in lumbar spine is a common issue that makes patients painful and limits them in some of daily activities. Traditional rehabilitation programs can relieve the symptoms but those will take lots of time and money. One kind of invasive treatment”epidural steroid injection” has beter used in many countries, but not been broadly received in Taiwan. So I want to study whether this treatment can get faster effects and spend a reasonable cost than the traditional rehabilitation programs. Methods : The patients with the main diagnosis of lumbar HIVD with root compression were separated into two groups. The experimental group received epidural steroid injection and traditional rehabilitative treatments. The control group received rehabilitative treatments only. Two groups both received in-hospital treatments. We collected the data of pre-treatment, one week and one month after the treatments. The effective indicators included decrease of back pain, decrease of leg pain, Oswestry Disability Index(ODI),and depressive scores. Then we compare the effect of two treatments, therapeutic cost, medicine cost and injection fee for cost-effectiveness analysis. Outcomes: The study group and control group had obvious improvement after the treatment one week and one month later . No significant difference was observed only in the depressive scores of the control group . The results indicated that both treatments are effective. Then we compare the differences between the two groups. The outcomes showed that the study group were better than the control group, especially in the decrease of LBP and ODI . In the analysis of ICER(ΔC/ΔE),the study group had better CEA. than the control group despite the experimental group had higher cost. Conclusion : The treatment of epidural steroid injection for HIVD patients is not popular in Taiwan and is costly . Based on the short-term effectiveness in our study, we can still have a conclusion that traditional rehabilitation programs combining this positive procedure can obviously relieve the back pain and improve the daily activities.