Cost-Effectiveness of Monotherapy versus Polypharmacy in Cervicobrachial Symptoms: A Nationwide Multicenter Analysis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ito Sadayuki, Nakashima Hiroaki, Wakao Norimitsu, Furuya Takeo, Yoshii Toshitaka, Arima Hideyuki, Yamato Yu, Imagama Shiro, Imajo Yasuaki, Miyamoto Hiroshi, Inoue Gen, Miyagi Masayuki, Kanbara Shunsuke, Iizuka Yoichi, Chikuda Hirotaka, Watanabe Kei, Kobayashi Kazuyoshi, Tsushima Mikito, Miyazaki Masashi, Yagi Mitsuru, Suzuki Satoshi, Takahata Masahiko, Hongo Michio, Koda Masao, Nagata Keiji, Mori Kanji, Suzuki Akinobu, Kaito Takashi, Murotani Kenta, Miyakoshi Naohisa, Hashizume Hiroshi, Matsuyama Yukihiro, Kawakami Mamoru, Haro Hirotaka, Project Committee of the Japanese Society for Spine Surgery and Related Research (JSSR)
Аннотация
METHODS: This prospective observational study, conducted through the Japanese Society for Spine Surgery and Related Research, included 261 adults with cervicobrachial symptoms across 28 institutions (July 2020 to July 2022). Patients received monotherapy (n=112) or multiple-drug therapy (n=149) using five pre-specified agents: loxoprofen, celecoxib, acetaminophen, tramadol-acetaminophen, and pregabalin. The primary outcome was quality-adjusted life years (QALYs), calculated from monthly EuroQol 5-Dimension 5-Level assessments over six months. The secondary outcomes were drug costs and incremental cost-effectiveness ratios (ICERs), evaluated against Japan's reference threshold of 5,000,000 JPY per QALY.
RESULTS: Mean QALY gains were similar between the monotherapy (0.00267±0.00544) and multiple-drug therapy (0.00284±0.00774) groups, with no statistically significant difference (p>0.05). However, total drug costs were substantially higher with multiple-drug therapy (19,243 JPY vs. 8,275 JPY). ICERs were more favorable for monotherapy (3,093,957 JPY/QALY) than for multiple-drug therapy (6,781,101 JPY/QALY). Among agents used as monotherapy, loxoprofen (744,409 JPY/QALY) and acetaminophen (781,293 JPY/QALY) showed the most favorable cost-effectiveness profiles, whereas tramadol-acetaminophen (6,370,451 JPY/QALY) and pregabalin (10,995,651 JPY/QALY) had the least favorable cost-effectiveness. Most QALY gains occurred during the first three months in both groups.
CONCLUSIONS: Multiple-drug therapy approximately doubled pharmaceutical costs without providing additional QALY gains over six months. Monotherapy, particularly with non-steroidal anti-inflammatory drugs or acetaminophen, offers superior cost-effectiveness and should be prioritized as first-line treatment. These findings underscore the need for restraint in polypharmacy and provide real-world evidence to guide clinical decision-making and national healthcare policy.