治疗背痛"效价比"较低.

readok2009

More pain than gain in treating backache

Many with spinal problems pay higher costs and do not see improvements in health, a study finds.

From Reuters
February 13, 2008

CHICAGO -- The total cost of treating back pain in the United States has risen 65% in the last decade, but after all the pricey treatments, many people are still left with an aching back and an increasingly empty wallet, U.S. researchers said Tuesday.

They said treating spine problems in the United States costs $85.9 billion a year, rivaling the economic burden of treating cancer, which costs $89 billion.

Higher spending on prescription drugs, more advanced diagnostic tests and more frequent outpatient visits helped drive the increases, as well as greater patient demand for treatment and more use of spinal fusion surgery and instruments, researchers said.

Yet, for all of the spending, they found people with spine problems actually felt worse.

\"Healthcare expenditures for people with spinal problems have increased substantially -- 65% since 1997. Within that, we found pharmaceutical expenditures have increased 171%,\" said Brook Martin of the University of Washington in Seattle, whose study appears in the Journal of the American Medical Assn.

\"If we are spending that much money on spine problems, we would expect to see improvements in the health of the population,\" Martin said in a telephone interview.

\"What this study shows is we are not seeing commensurate improvements among people with spine problems.\"

Martin and colleagues analyzed data from 1997 to 2005 from a nationally representative survey of patient health expenditures and health status.

They found that in 1997 people with spine problems on average spent $4,695 a year, adjusted for inflation, compared with the average $2,731 spent for people without back problems.

The average health cost for spine patients in 2005 rose to $6,096, compared with $3,516 for people without those problems.

The proportion of spine patients reporting physical, social and work limitations rose to 24.7% in 2005 from 20.7% in 1997.

\"What we're seeing is that although costs have gone up, outcomes have not changed, which is really discouraging,\" said Dr. Orly Avitzur, a neurologist from Tarrytown, N.Y., and an advisor to Consumer Reports, which recently named back surgery on its top-10 list of \"Medical Gotchas.\"

The research follows a number of recent studies showing that some patients who skip surgery for back pain fare just as well over time as those who have the surgery.

\"It's best to be conservative and take a wait-and-see approach, especially in the initial stages of low back pain,\" Avitzur said in a telephone interview.

Dr. Paul Rubery, a spine surgeon at the University of Rochester Medical Center in New York, said that higher drug spending and increased use of diagnostic tests such as MRI accounted for a lot of the increased costs.

He said the study emphasized the need for treatments with proven benefits.

Dr. Richard Fessler, a professor of neurosurgery at Northwestern University in Chicago, challenged the study's findings and methodology. \"I think their conclusions are unwarranted and very misleading,\" he said.

Fessler, in an e-mail, said the study did not mention several large recent clinical trials that showed certain patients undergoing spinal surgery had improved significantly.

Martin said his work was not an indictment of any one approach to treating back pain. \"This study is a broad view of trends overall,\" he said.

\"Really, the goal should be to match the right treatment to the right patient who will benefit from it. I think that is sometimes where we fall short,\" Martin said.

http://www.latimes.com/features/health/la-na-backpain13feb13,1,6229571.story?ctrack=3&cset=true

主标题:研究发现,许多脊柱疾患者花费很多却疗效甚微.
副标题:治疗背痛\"效价比\"较低.

路透社,08年2月13日,芝加哥消息:周二美国研究人员们说,在过去的10年间,美国用于治疗背痛的总费用增长了65%,然而在接受了所有昂贵的治疗策略之后,患者们一贫如洗却仍在遭受背痛折磨.

研究背景:
美国用于治疗脊柱病症的费用为每年859亿,与治疗癌症共同构成两大经济负担,后者每年花费为890亿.其增长原因有:处方药花费增高,新增先进的诊断测试,更多的门诊病人,以及患者治疗要求增多,脊柱融合手术与器械使用增多.然而,虽花费如此之多,脊柱病症者症状实际上却在加重.

研究策略及发现:
分析来自一项具有代表性的关于97至05年间美国人口健康支出及健康状况调查的数据。发现，97年花费在脊柱病症上的平均费用为每人每年4695美圆（因通货膨胀而有所调整），而用于非背痛患者的人均费用为每年2731美圆。05年脊柱病患人均费用增至每年6096美圆，而其他病患的人均费用为每年3516美圆。脊柱病症者报道出现身体，社交及工作能力受限之比例从97年的20.7%增至05年的24.7%。

研究结论:
来自西亚图,华盛顿大学的Brook Martin(其研究发表在“美国医学联盟杂志”上)认为研究提示,脊柱病症耗费医疗资源巨大,却疗效甚微.

正方观点:保守与观望需要优先考虑&掌握适应症很重要.
1,来自Tarrytown, N.Y.(纽约一地名)的神经科医师,\"消费者报告杂志\"(该杂志近期将背痛手术治疗列为10个“医疗尖端治疗”排行的首位。)的顾问Orly Avitzur认为,最好是采取保守治疗和观望策略,尤其是在背痛刚开始出现的阶段.
2,来自纽约罗契斯特医学中心大学,脊柱外科医师Paul Rubery认为,研究强调了使用获益确实的治疗策略的重要性.

反方观点:不够全面客观,有误导性.
来自芝加哥西北大学的神经外科学教授,Richard Fessler博士认为,研究并没有提到近期所进行的一些大规模临床试验中,某些接受脊柱手术的患者症状改善显著.所以,研究结论可靠性不强,且具有误导性.

研究方观点:或许存在治疗过度.
研究是对整体趋势的一个全面考量.目的是为了让病人得到适合的治疗措施,因为在治疗策略选择上面有时做的不足.