Bozic Kevin J, Morshed Saam, Silverstein Marc D, Rubash Harry E, Kahn James G
Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus, MU 320W, San Francisco, CA 94143-0728, USA.
J Bone Joint Surg Am. 2006 Apr;88(4):706-14. doi: 10.2106/JBJS.E.00614.
Alternative bearing surfaces offer the potential to reduce wear and improve implant longevity following total hip arthroplasty. However, these technologies are associated with higher costs, the potential for unintended consequences, and uncertain benefits in terms of long-term survival of the implants. The purpose of this study was to evaluate the cost-effectiveness of the use of alternative bearings in total hip arthroplasty.
A decision-analysis model was constructed to estimate the cost-effectiveness of the use of alternative bearings for patients undergoing total hip arthroplasty. Model inputs, including costs, clinical outcome probabilities, and health utility values, were derived from a review of the literature. Sensitivity analyses were performed to evaluate the impact of patient age at the time of surgery, implant costs, and reductions in revision rates on the cost-effectiveness of alternate bearing surfaces.
In a population of fifty-year-old patients, use of an alternative bearing with an incremental cost of 2000 dollars would be cost-saving over the individual's lifetime if it were associated with at least a 19% reduction in the twenty-year implant failure rate when compared with the failure rate for a conventional bearing. In a population of patients over the age of sixty-three years, the same implant would be associated with higher lifetime costs than would a conventional bearing, regardless of the presumed reduction in the revision rate. Conversely, an alternative bearing that adds only 500 dollars to the cost of a conventional total hip arthroplasty could be cost-saving in a population of patients over the age of sixty-five years, even if it were associated with only a modest reduction in the revision rate. In a population of patients over the age of seventy-five years, no alternative bearing would be associated with lifetime cost-savings, regardless of the cost or the presumed reduction in the revision rate.
The cost-effectiveness of alternative bearings is highly dependent on the age of the patient at the time of surgery, the cost of the implant, and the associated reduction in the probability of revision relative to that associated with conventional bearings. Our findings provide a quantitative rationale for requiring greater evidence of effectiveness in reducing the probability of implant failure when more costly alternative bearings are being considered, particularly for older patients.
在全髋关节置换术后，采用替代关节面有潜力减少磨损并提高植入物使用寿命。然而，这些技术成本更高，存在产生意外后果的可能性，且在植入物长期存活方面的益处尚不明确。本研究的目的是评估在全髋关节置换术中使用替代关节面的成本效益。
构建了一个决策分析模型，以估计全髋关节置换患者使用替代关节面的成本效益。模型输入数据，包括成本、临床结局概率和健康效用值，均来自文献综述。进行敏感性分析，以评估手术时患者年龄、植入物成本以及翻修率降低对替代关节面成本效益的影响。
在50岁患者群体中，如果与传统关节面相比，使用成本增加2000美元的替代关节面能使20年植入物失败率至少降低19%，那么在个体一生中使用该替代关节面将节省成本。在63岁以上患者群体中，无论假定的翻修率降低多少，同一植入物的终身成本都将高于传统关节面。相反，在65岁以上患者群体中，即使仅使翻修率适度降低，一种仅使传统全髋关节置换成本增加500美元的替代关节面也可能节省成本。在75岁以上患者群体中，无论成本或假定的翻修率降低情况如何，没有哪种替代关节面能带来终身成本节省。
替代关节面的成本效益高度依赖于手术时患者的年龄、植入物成本以及相对于传统关节面翻修概率的相关降低情况。我们的研究结果为在考虑采用成本更高的替代关节面时，尤其是对于老年患者，需要有更有力的有效性证据以降低植入物失败概率提供了定量依据。
