ARTICULO A TEXTO COMPELTO AQUI
Cost-effectiveness of Surgery in the Management of Metastatic Epidural
Spinal Cord Compression: A Systematic Review
Study Design. Systematic review.
Objective. To perform an evidence-based synthesis of the literature to
examine the cost-effectiveness of surgery in the management of metastatic
epidural spinal cord compression (MESCC).
Summary of Background Data. Between 2.5% and 10% of patients with cancer
develop symptomatic MESCC, which leads to significant morbidity, and a
reduction in quality and length of life. Although surgery is being
increasingly used in the management of MESCC, it is unclear whether this
modality is cost-effective, given the relatively limited lifespan of these
patients.
Methods. Numerous databases were searched to identify full economic studies
based on key questions established *a priori*. Only economic studies that
evaluated and synthesized the costs and consequences (*i.e*.,
cost-minimization, cost-benefit, cost-effectiveness, or cost-utility) were
considered for inclusion. Two independent reviewers examined the full text
of the articles meeting inclusion criteria to obtain the final cohort of
included studies. The Quality of Health Economic Studies instrument was
scored by 2 independent reviewers.
Results. The search strategy yielded 38 potentially relevant citations, 2
of which met the inclusion criteria. One was a cost-utility study and the
other was a cost-effectiveness study, and both used clinical data from the
same randomized controlled trial. Both studies found surgery plus
radiotherapy to be not only more expensive but also more effective than
radiotherapy alone in the management of patients with MESCC.
Conclusion. There is evidence from 2 high-quality studies that surgery plus
radiotherapy is costlier but clinically more effective than radiotherapy
alone for the management of MESCC. Of note, cost-effectiveness data for the
role of spinal stabilization in the management of oncological spinal
instability are lacking. This is a key knowledge gap that represents an
opportunity for future research.