Penny-wise and pound-foolish
Penny-wise and pound-foolish
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小事明智，大事愚蠢
DOI：
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
B. Devitt
中科院分区：
文献类型：
--
作者：
A. Årøen;B. Devitt
这一期的KSSTA杂志有一个关于并发前交叉韧带（ACL）和软骨损伤的特别部分。这两种疾病是非常常见的问题，其治疗不仅对国际卫生保健系统而且对整个社会都是一个重大的财政负担。由于医疗保健的资源不是无限的，我们作为整形外科医生，必须意识到我们为患者提供的手术和康复的成本。但是，重要的不仅仅是衡量货币成本，而是成本效益比，它让我们对我们提供的治疗的整体价值有更好的印象。正如英国谚语所说，我们是否冒着“因小失大”的风险，试图在最初的治疗费用上偷工减料，结果却在长期的生产力损失和慢性残疾方面付出高昂的代价？在软骨手术的背景下，鉴于患者群体通常是年轻的，治疗费用必须考虑到这些患者返回有报酬的就业的社会储蓄。之前已经证明，局灶性软骨病变患者会出现明显的疼痛和功能障碍症状，其生活质量受到的影响程度与计划接受全膝关节置换术（TKA）的患者相同[6]。因此，考虑到TKA的价格超过了大多数软骨修复手术的价格，我们是否应该认为无论成本如何，生物替代品的投资都是值得的[10]？另一方面，有些人可能会认为，虽然TKA通常是一种非常可靠的手术，并且物有所值，但膝关节软骨修复手术并不总是如此。诺贝尔经济学奖获得者米尔顿弗里德曼在一次著名的关于花钱方式的采访中概述了一个人对花钱的态度的重要区别，这取决于钱属于谁，这在这个讨论中非常相关：“你可以把自己的钱花在自己身上。当你这样做时，为什么你真的要小心你在做什么，并且你会尽力让你的钱发挥最大作用.如果我把别人的钱花在别人身上，我不关心它有多少钱，我也不关心我得到了什么。这就是政府”。考虑到这种情绪，让我们考虑两种情况，如果我们必须支付治疗以下两种膝关节疾病的费用，我们将如何花费自己的钱：（1）一名28岁男性患者的股骨内侧髁孤立的2 cm × 2 cm软骨病变，对线正常;（2）同一患者的ACL断裂合并相同的软骨病变。场景1-股骨内侧髁的孤立性软骨损伤。首先，让我们看看治疗方案，看看哪一个是最好的，不管费用。在这种情况下，我们被宠坏的选择，因为有无数 * Asbjorn. medisin.uio.no
This issue of the KSSTA journal has a special section on concurrent anterior cruciate ligament (ACL) and cartilage injuries. These two conditions are very common problems and the treatment of which represents a significant financial burden not only on healthcare systems internationally but also on society in general. As resources in healthcare are not unlimited, we, as orthopedic surgeons, must be conscious of the cost of surgery and rehabilitation we provide for our patients. But, it is not simply a measure of the monetary cost that it is important, it is the cost to benefit ratio that gives us a better impression of the overall value of the treatment we provide. As the British saying goes do we run the risk of being ‘penny-wise and pound-foolish’ by trying to cut corners on the initial cost of treatment only to pay dearly in terms of lost productivity and chronic disability in the long-run? In the context of cartilage surgery, given that the patient population is typically young, the cost of treatment must be considered against the societal saving of returning these patients to gainful employment. It has previously been shown that patients with focal cartilage lesions suffer with significant symptoms of pain and functional impairment and their quality of life is affected to the same extent as patients scheduled for a total knee arthroplasty (TKA) [6]. Therefore, considering the price of a TKA exceeds that of most cartilage restoration procedures, should we consider the investment in a biological alternative as money well spent no matter the cost [10]? On the other hand, some might argue that whereas TKA is typically a very reliable procedure and delivers value for money, the same is not always true of cartilage restoration procedures in the knee. Milton Friedman, a nobel prize winning economist, in a famous interview on the ways to spend money outlined an important distinction about one’s attitude to spending based on who the money belongs to, which is quite relevant in this discussion: “You can spend your own money on yourself. When you do that, why then you really watch out what you’re doing, and you try to get the most for your money... And if I spend somebody else’s money on somebody else, I’m not concerned about how much it is, and I’m not concerned about what I get. And that’s government.” With this sentiment in mind, let us consider two scenarios of how we would spend our own money if we had to pay to treat the two following knee conditions: (1) An isolated 2 cm × 2 cm cartilage lesion of the medial femoral condyle in a 28-year-old male patient with normal alignment: and (2) A combined ACL rupture with the same cartilage lesion in the same patient. Scenario 1—An isolated chondral lesion of the medial femoral condyle. First, let us examine the treatment options and see which one is the best regardless of the expense. In this instance, we are spoilt for choice as there are a myriad * Asbjørn Årøen asbjorn.aroen@medisin.uio.no
影响因子：
5.3
作者：
Mather, Richard C., III;Koenig, Lane;Spindler, Kurt P.
通讯作者：
Spindler, Kurt P.