Tosteson A N, Gabriel S E, Grove M R, Moncur M M, Kneeland T S, Melton L J
Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA.
Osteoporos Int. 2001 Dec;12(12):1042-9. doi: 10.1007/s001980170015.
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 1 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.
该研究的目的是使用一种适用于经济评估的基于偏好的健康指标，评估髋部骨折和椎体骨折对绝经后女性生活质量的影响，并调查健康结果的相关因素。对50岁及以上无骨质疏松性骨折的女性与有髋部和/或椎体骨折的女性进行访谈，以评估与健康相关的生活质量，访谈中还记录了其他健康状况和特征。健康状况通过自我报告的身体限制以及SF-36的心理和身体成分汇总得分来表征。使用时间权衡值估计质量调整生命年（QALY），其反映了每个人对其总体健康效用的评估。回归方法用于检查每个骨折组的QALY相关因素（如骨折后的时间），并在考虑其他患者特征后估计骨折组和非骨折组之间QALY的差异。在382名年龄在50-96岁的女性中，骨折组女性比非骨折组女性年龄显著更大，使用激素替代疗法的可能性更低，报告身体限制的可能性更高。在QALY量表上，1代表完美健康，0代表死亡，114名有一处或多处椎体骨折的女性的平均QALY值为0.82（95%CI：0.76，0.87），67名髋部骨折女性的平均QALY值为0.63（95%CI：0.52，0.74），而201名无骨折女性的平均QALY值为0.91（95%CI：0.88，0.94）。仅椎体骨折的女性中未发现QALY的显著相关因素。在髋部骨折患者中，髋部骨折后的时间和椎体骨折的存在是QALY的显著相关因素。在多元回归分析中，估计的QALY差异（骨折组减去非骨折组）范围为-0.05至-0.55，分别相当于椎体骨折（p = 0.001）、髋部骨折（p = 0.009）和髋部加椎体骨折（p<0.001）患者每年损失20-58天、23-65天和115-202天，具体取决于年龄。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，即使是在髋部骨折存活的女性中。
