Zusammenfassung
Aufgabenstellung: Die Möglichkeiten zur Kostensenkung in der Wirbelsäulenchirurgie sollen nach Analyse der Implantatkosten und deren Behandlungseffizienz überprüft werden.
Material und Methodik: Die Kosten für Wirbelsäulenimplantate und Halo-Fixateur-Systeme für die Wirbelsäulenabschnitte kraniozervikal, HWS, BWS, LWS wurden nach einer Preisanalyse der Jahre 2001 und 2002 zusammengestellt und die Implantate nach deren wissenschaftlichen Behandlungseffizienz überprüft. Alle Preise über 100 € wurden in 50-€-Schritten aufgerundet. Für die Implantate wurde eine Literaturrecherche durchgeführt und die wissenschaftlichen Arbeiten in ihrer Evidenzstärke (I a-IV) in vergleichend und ohne Vergleich zu einem anderen Implantat unterteilt.
Ergebnisse: Kraniozervikal: Halo-Fixateure 1 700-2 500 €, Densschraube 100-250 €, Platte 1 300 €, Drähte 20-200 €, Platte-Draht-, Stab-Draht-, Stab-Schraubensysteme 400-1 800 €, Klammersysteme 1 200 €; HWS: Platzhalter 20-500 €, Wirbelkörperersatzsysteme 400-1 300 €, Platten 75 -450 €, Stab-/Platte-Schraubensysteme 900-1 700 €; BWS/LWS: Platte-/Stabsysteme 1 000-2 800 €, Wirbelkö rperersatz 500-1 300 €, Fixateur interne 800-2 500 €, Cages 600-1 500 €. Für kein Implantat fand sich eine vergleichende wissenschaftliche klinische Arbeit mit einer hohen Evidenzstärke (I a-I b).
Schlussfolgerungen: Bei einer pragmatischen Auswahl der Implantate können die Kosten reduziert werden. Die Kosten- Nutzen-Analyse neuer Methoden an der Wirbelsäule im Sinne einer evidence-based spine surgery muss stärker in den Mittelpunkt gerückt werden. Fremdkontrollierte prospektive vergleichende Multizenterstudien und Metaanalysen werden deshalb zur Evaluierung der verschiedenen Verfahren gefordert.
Abstract
Objective: To evaluate the possibilities for cost reduction in spinal surgery by analysing implant costs and the efficiency of each type of implant.
Materials and Methods: The costs of spinal implant methods, as well as Halo-vest for craniocervical, cervical, thoracic, lumbar spine are summarised according to an analysis of price lists from 2001 and 2002. The different methods were additionally evaluated with regard to the scientifically-based treatment efficiency. All prices above 100 € were rounded up to the closest 50 €. For the implants, a literature research was performed. The scientific papers were divided into groups according to their level of evidence (I a -IV), and then further subdivided into comparable and non-comparable categories.
Results: Craniocervical: Halo-vest 1 700-2 500 €, odontoidscrew 100-250 €, plate 1 300 €, wire 20-250 €; plate-wire-, rod-wire- or rod-screw systems 400-1 800 €, clamps 1 200 €, Cervical: placeholder 20-500 €, vertebral body replacement 400-1 300 €, plate 75-450 €; rod- or plate-screw systems 900-1 700 €; Thoracic/lumbar: plate/rod-systems 1 000-2 800 €, vertebral body replacement 500-1 300 €, internal fixateur 800-2 500 €, cages 600-1 500 €. For none of the implant methods were comparable scientific clinical publications found with a high levels of evidence (I a-I b).
Conclusions: Costs can be reduced through a more thorough investigation and corresponding choice of implant method. The cost-benefit analysis of new spinal implants must be considered more with regard to the evidence-based spinal surgery. In order to sufficiently evaluate the different treatment methods, future multicenter controlled comparable studies and meta-analyses must be undertaken.
Schlüsselwörter
Wirbelsäulenimplantate - evidenzbasierte Medizin - Kosten- Nutzen-Analyse
Key words
Spine implants - evidence-based medicine - costs-benefit-analysis
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Dr. med. U. Vieweg
Zentrum für Wirbelsäulenstabilisierungen am Leopoldina-Krankenhaus
Gustav-Adolf-Straße 8
97422 Schweinfurt
Phone: 0 97 21-7 20 61 85
Fax: 0 97 21-7 20 29 92
Email: uvieweg@leopoldina.de
