Long-term Health-related Quality of Life of Total Hip Arthroplasty Patients and Cost-effectiveness Analysis in the Japanese Universal Health Insurance System
Long-term Health-related Quality of Life of Total Hip Arthroplasty Patients and Cost-effectiveness Analysis in the Japanese Universal Health Insurance System
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日本全民健康保险体系中全髋关节置换术患者的长期健康相关生活质量及成本效益分析
DOI：
10.1111/jjns.12537
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发表时间：
2023
影响因子：
1.7
通讯作者：
Kanako Yakushiji
中科院分区：
文献类型：
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作者：
馬殿 恵;仁木 暁子;堀井 知美;石橋 千咲;藤田 真吾;藤田 有可里;木村 武量;徳永 あゆみ;南茂 隆生;福井 健司;小澤 純二;下村 伊一郎;Kanako Yakushiji
目的人工全髋关节置换术能有效改善终末期骨性关节炎患者的活动能力。本研究的目的是：(1)比较人工全髋关节置换术和非人工全髋关节置换术的使用价值的渐进性变化；(2)评价全髋关节置换术的成本-效果；(3)通过年龄、诊断和合并症来评估成本-效果。患者于术前及术后1、3、5、7 年完成EUROQOL。为了得出获得的质量调整后的生命年，从EuroQol项目得分中获得效用分数，并结合7个 年，通过以2%-4%的年率贴现术后1年的效用值来获得估计。结果平均总成本为1,921,849日元，质量调整寿命年收益得分为1.746，平均成本为1,100,715日元。与实际测量相比，术后1至7年 的估计值有显著差异，并观察到相互作用。关于年龄，患者年龄越大，经质量调整的生命年的成本越高。术前身体功能较差的患者有较高的质量调整寿命年收益，而每质量调整生命年的成本较低。结论全髋关节置换术是一种经济有效的方法。与实际测量相比，术后1至7年 的估计效用值有显著差异。即使是年龄较大的患者和术前身体功能受损的患者，其成本也低于日本患者的支付意愿。
AimTotal hip arthroplasty can effectively improve patients' motility with end‐stage osteoarthritis. This study aimed to: (1) compare gradual changes in utility values with total hip arthroplasty and estimated values without; (2) evaluate total hip arthroplasty cost‐effectiveness; and (3) evaluate cost‐effectiveness by age, diagnosis, and comorbidity.MethodsPatients who underwent total hip arthroplasty between January 2008 and December 2009 were included. Patients completed the EuroQol preoperatively and at 1, 3, 5 and 7 years postoperatively. To derive the quality‐adjusted life years gained, a utility score was obtained from the EuroQol item scores and combined with 7 years, and estimates were obtained by discounting the postoperative 1‐year utility value at an annual rate of 2%–4%. Mixed‐effects regression models were used to compare the estimated and the measured utility values.ResultsMean total cost was 1,921,849 yen, and quality‐adjusted life years gain score was 1.746 with per cost as 1,100,715 yen. Compared with actual measurements, the estimated values from 1 to 7 years post‐surgery differed significantly, and interaction was observed. Regarding age, the older the patient, the higher the cost per quality‐adjusted life years. Patients with lower preoperative physical function had higher quality‐adjusted life years gains, while the cost per quality‐adjusted life years was lower.ConclusionsTotal hip arthroplasty was cost‐effective. Compared with actual measurements, the estimated utility values from 1 to 7 years post‐surgery significantly differed. Even among older patients and those with impaired preoperative physical functions, its cost was lower than patients' willingness to pay in Japan.