LA CIRUGIA SEGUIDA DE LA RADIOTERAPIA ES LA OPCION MAS COSTE-EFECTIVA EN EL TRATAMIENTO DE LAS METASTASIS VERTEBRALES



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.