Cross M J, March L M, Lapsley H M, Tribe K L, Brnabic A J, Courtenay B G, Brooks P M
Department of Medicine, St Vincent's Hospital, University of NSW, Sydney, Australia.
Rheumatology (Oxford). 2000 Nov;39(11):1242-8. doi: 10.1093/rheumatology/39.11.1242.
To determine whether patients with osteoarthritis (OA) would be willing to pay for joint replacement and whether patient characteristics or health outcomes, including pain, physical function and health-related quality of life, were related to willingness to pay (WTP).
Patients who had undergone primary total hip replacement (THR) or total knee replacement (TKR) for OA completed a disease-specific questionnaire (Western Ontario and McMaster: WOMAC index), a generic measure of health status (Medical Outcome Study Short Form-36: SF-36) and an Evaluation Questionnaire to measure WTP and satisfaction with the replacement.
Responses were obtained from 109 (77%) THR patients and 129 (72%) TKR patients. Mean age of respondents was 67 yr for THR (47% female) and 73 yr for TKR (60% female). Overall, 85% of patients responded to the WTP question. Of the THR patients, 71% were willing to pay something, 11% were not willing to pay anything and 18% did not answer the question. For TKR patients these figures were 70, 16 and 14% respectively. However, of those who responded to the WTP question, only 25% of the THR patients and 18% of the TKR patients indicated they would be willing to pay the actual current average cost of the operation in Australia (>/= A$15 000). A lower postoperative pain score (as measured by the WOMAC index) was a significant predictor of WTP for both THR and TKR patients. Income also significantly predicted WTP in THR patients but not in TKR patients. The other significant predictors for TKR patients were older age, having private health insurance and willingness to recommend joint replacement to others.
Willingness to pay was a measure that was understandable and acceptable to patients, most of whom were willing to pay something. There was a high correlation between WTP, good health outcomes and patient satisfaction, pain relief being the dominant determinant.
确定骨关节炎（OA）患者是否愿意为关节置换付费，以及患者特征或健康结果（包括疼痛、身体功能和与健康相关的生活质量）是否与支付意愿（WTP）相关。
因OA接受初次全髋关节置换（THR）或全膝关节置换（TKR）的患者完成了一份特定疾病问卷（西安大略和麦克马斯特大学骨关节炎指数：WOMAC指数）、一项健康状况通用测量指标（医学结局研究简表-36：SF-36）以及一份评估问卷，以测量WTP和对置换手术的满意度。
获得了109名（77%）THR患者和129名（72%）TKR患者的回复。THR患者的平均年龄为67岁（女性占47%），TKR患者的平均年龄为73岁（女性占60%）。总体而言，85%的患者回答了WTP问题。在THR患者中，71%愿意支付一定费用，11%不愿意支付任何费用，18%未回答该问题。对于TKR患者，这些数字分别为70%、16%和14%。然而，在回答WTP问题的患者中，只有25%的THR患者和18%的TKR患者表示他们愿意支付澳大利亚目前该手术的实际平均费用（≥15000澳元）。术后疼痛评分较低（通过WOMAC指数测量）是THR和TKR患者WTP的重要预测因素。收入也是THR患者WTP的显著预测因素，但不是TKR患者的预测因素。TKR患者的其他重要预测因素包括年龄较大、拥有私人医疗保险以及愿意向他人推荐关节置换手术。
支付意愿是患者能够理解和接受的一项指标，大多数患者愿意支付一定费用。WTP、良好的健康结果和患者满意度之间存在高度相关性，疼痛缓解是主要决定因素。
