A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip
A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip
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DOI：
10.1001/jama.275.11.858
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发表时间：
1996-03-20
影响因子：
120.7
通讯作者：
Hazen, GB
中科院分区：
文献类型：
--
作者：
Chang, RW;Pellissier, JM;Hazen, GB
目的：量化预期增加的短期和长期成本与预期增加的全髋关节置换术(THA)相关的质量调整预期寿命(QALE)之间的权衡。设计：通过构建随机树和决策分析模型，从社会的角度进行成本-效果研究，该模型旨在估计全髋关节置换和非手术治疗的终生功能结果和成本。主要结果衡量标准。-采用改良的四州美国风湿病学会功能状态分类来衡量疗效。这些功能类被分配了效用值，以允许以质量调整的生命年(QALY)来表达THA的相对有效性，终身成本包括与初次和潜在翻修手术相关的成本，以及与功能依赖类相关的长期护理成本。成本-效果模型中使用的数据。-概率和发病率数据总结自文献。结果：全髋关节的成本-效果比随着年龄的增长而增加，男性的成本-效果比高于女性，在基本情况下，对于患有功能性显著但不依赖的髋骨关节炎的60岁的白人女性，该模型预测全髋关节是节省成本的，因为由于髋关节骨关节炎的恶化导致依赖的托管护理的高成本，并且该手术使QALE增加了约6.9年。在85岁及以上男性的基本情况下，与非手术治疗相关的平均终身成本为9100美元，QALE平均增加约2年。因此，85岁及以上男性的全髋关节置换的成本-效果比为4600美元/QALY，低于冠状动脉搭桥术或肾透析等旨在延长生命的手术。最坏情况分析表明，对于这一年龄最大的年龄类别(8万美元/QALY)，全髋关节置换仍然是最低限度的成本效益，即使概率、比率、公用事业、成本和贴现率同时变化到极端值，从而使分析偏向于手术。结论-对于与显著功能受限相关的髋骨关节炎患者，全髋关节置换可以节省成本，或者在最坏的情况下，当同时考虑短期和长期结果时，在改善QALE方面具有成本效益，需要进一步研究以确定这一程序是否真的以这种具有成本效益的方式使用，特别是在老年类别中。
Objective.-To quantify the trade-off between the expected increased short- and long-term costs and the expected increase in quality-adjusted life expectancy (QALE) associated with total hip arthroplasty (THA) for persons with functionally significant hip osteoarthritis.Design.-A cost-effectiveness study was performed from the societal perspective by constructing stochastic tree, decision analytic models designed to estimate lifetime functional outcomes and costs of THA and nonoperative managements.Main Outcome Measures.-A modified four-state American College of Rheumatology functional status classification was used to measure effectiveness. These functional classes were assigned utility values to allow the relative effectiveness of THA to be expressed in quality-adjusted life years (QALYs), Lifetime costs included costs associated with primary and potential revision surgeries and long-term care costs associated with the functionally dependent class.Data Used in the Cost-effectiveness Model.-Probability and incidence rate data were summarized from the literature. The THA hospital cost data were obtained from local teaching hospitals' cost accounting systems, Estimates of recurring medical costs for functionally significant hip osteoarthritis and for custodial care were derived from the literature.Results.-The THA cost-effectiveness ratio increases with age and is higher for men than for women, In the base-case scenario for 60-year-old white women who have functionally significant but not dependent hip osteoarthritis, the model predicts that THA is cost saving because of the high costs of custodial care associated with dependency due to worsening hip osteoarthritis and that the procedure increases QALE by about 6.9 years. In the base-case scenario for men aged 85 years and older, the average lifetime cost associated with THA is $9100 more than nonoperative management, with an average increase in QALE of about 2 years. Thus, the THA cost-effectiveness ratio for men aged 85 years and older is $4600 per QALY gained, less than that of procedures intended to extend life such as coronary artery bypass surgery or renal dialysis, Worst-case analysis suggests that THA remains minimally cost-effective for this oldest age category ($80 000/QALY) even if probabilities, rates, utilities, costs, and the discount rate are simultaneously varied to extreme values that bias the analysis against surgery.Conclusions.-For persons with hip osteoarthritis associated with significant functional limitation, THA can be cost saving or, at worst, cost-effective in improving QALE when both short- and long-term outcomes are considered, Further research is needed to determine whether this procedure is actually being used in this cost-effective manner, especially in older age categories.