Impact of hip and vertebral fractures on quality-adjusted life years
Impact of hip and vertebral fractures on quality-adjusted life years
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DOI：
10.1007/s001980170015
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发表时间：
2001-01-01
影响因子：
4
通讯作者：
Melton, LJ
中科院分区：
文献类型：
--
作者：
Tosteson, ANA;Gabriel, SE;Melton, LJ
这项研究的目的是使用一种适合于经济评估的基于偏好的健康指标来评估髋部和脊椎骨折对绝经后妇女生活质量的影响，并调查健康结果的相关性。评估与健康相关的生活质量的访谈，其中还记录了其他健康状况和特征。与髋部和/或椎体骨折的女性相比，50岁及以上没有骨质疏松性骨折的女性接受了这项研究(S)。健康状况的特征是自我报告的身体限制以及SF-36的精神和身体部分总分。质量调整寿命年(QALY)反映了每个人对其整体健康效用的评估，并使用时间权衡价值进行了估计。使用回归方法检查每个骨折组的QALY相关性(例如，自骨折以来的时间)，并在考虑其他患者特征后估计骨折和非骨折受试者之间的QALY差异。在382名年龄在50-96岁的女性中，骨折受试者比非骨折受试者年龄大得多，不太可能使用激素替代疗法，更有可能报告身体局限性。在QALY量表(I代表完全健康，0代表死亡)中，114名有一个或多个椎体骨折的女性的平均QALY值为0.82(95%CI：0.76，0.87)，67名髋部骨折患者的平均QALY值为0.63(95%CI：0.52，0.74)，而201名未骨折女性的平均QALY值为0.91(95%CI：0.88，0.94)。在单独患有脊椎骨折的女性中，QALY没有显著的相关性。在髋部骨折受试者中，髋部骨折后的时间和椎体骨折的存在与QALY显著相关。在多元回归分析中，根据年龄的不同，脊柱骨折(p=0.001)、髋部骨折(p=0.009)和髋部加脊柱骨折(p<；0.001)患者的估计QALY差异(骨折和非骨折受试者)分别相当于每年损失20-58天、23-65天和115-202d。因此，为了充分评估骨质疏松症治疗的成本效益，必须考虑椎体骨折对QALY的负面影响，即使是在髋部骨折后存活的女性中也是如此。
The objective of the study was to estimate the impact of hip and vertebral fractures on quality of life in postmenopausal women using a preference-based health measure that is appropriate for economic evaluations and to investigate correlates of health outcome. Interviews to assess health-related quality of life, which also documented other health conditions and characteristics. were undertaken in women age 50 years and older without osteoporotic fractures compared with women with hip and/or vertebral fracture(s). Health status was characterized by self-reported physical limitations and the mental and physical component summary scores of the SF-36. Quality-adjusted life years (QALYs), which reflect each individual's assessment of her overall health utility, were estimated with time tradeoff values. Regression methods were used to examine QALY correlates (e.g. time since fracture) for each fracture group and to estimate differences in QALYs between fracture and non-fracture subjects after accounting for other patient characteristics. Among 382 women ages 50-96 years, fracture subjects were significantly older, less likely to use hormone replacement therapy and more likely to report physical limitations than non-fracture subjects. On the QALY scale, where I represents perfect health and 0 represents death, mean QALY values were 0.82 (95% CI: 0.76, 0.87) among 114 women with one or more vertebral fractures and 0.63 (95% CI: 0.52, 0.74) among 67 with hip fracture compared with 0.91 (95% CI: 0.88, 0.94) among 201 women without fracture. No significant correlates of QALYs were identified among women with vertebral fracture alone. Among hip fracture subjects, time since hip fracture and presence of a vertebral fracture were significant correlates of QALYs. In multiple regression analyses, estimated QALY differences (fracture minus non-fracture subjects) ranged from -0.05 to -0.55 and were equivalent to losses of 20-58 days, 23-65 days and 115-202 days per year for vertebral fracture (p = 0.001), hip fracture (p = 0.009) and hip plus vertebral fracture (p < 0.001) subjects, respectively, depending on age. Thus to adequately assess the cost-effectiveness of osteoporosis treatment, the negative impact of vertebral fractures on QALYs, even among women who have survived a hip fracture, must be considered.