单髁膝关节置换术作为单间室骨关节炎全膝关节置换术替代方案的成本效益分析

Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis.

作者信息

Soohoo Nelson F, Sharifi Husham, Kominski Gerald, Lieberman Jay R

机构信息

Department of Orthopaedic Surgery, University of California at Los Angeles, 10945 Le Conte Avenue, Los Angeles, CA 90095, USA.

出版信息

J Bone Joint Surg Am. 2006 Sep;88(9):1975-82. doi: 10.2106/JBJS.E.00597.

DOI:10.2106/JBJS.E.00597

PMID:16951114

Abstract

BACKGROUND

The purpose of this study was to compare the cost-effectiveness of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty in patients with degenerative arthritis limited to either the medial or lateral compartment.

METHODS

A decision model was created for the treatment of end-stage unicompartmental knee arthritis. A literature review was used to identify possible outcomes and their probabilities following treatment with either unicompartmental or total knee arthroplasty. Each outcome was weighted for quality of life with use of a utility factor, and effectiveness was expressed in units of quality-adjusted life years. Gross costs were estimated from Medicare reimbursement data for the relevant Current Procedural Terminology and Diagnosis-Related Group codes.

RESULTS

Sensitivity analysis demonstrated that the cost-effectiveness of unicompartmental knee arthroplasty is dependent on the assumption that its durability and functional outcomes approach those of total knee arthroplasty. Specifically, it is necessary for the survival of unicompartmental implants to be within three to four years of the assumed survival of total knee implants for unicompartmental arthroplasty to remain a cost-effective alternative. Under these assumptions, the use of unicompartmental arthroplasty is a cost-effective choice as it results in incremental gains in effectiveness at a cost of less than US dollars 50,000 (in 1998 United States dollars) per quality-adjusted life year gained.

CONCLUSIONS

This study supports unicompartmental knee arthroplasty as a cost-effective alternative for the treatment of unicompartmental arthritis when the durability and function of a unicompartmental replacement are assumed to be similar to those of a primary total knee replacement. This suggests that, with appropriate patient selection, the currently available literature supports unicompartmental arthroplasty as a cost-effective alternative to total knee arthroplasty.

LEVEL OF EVIDENCE

Economic and decision analysis, Level II.

摘要

背景

本研究的目的是比较单髁膝关节置换术与全膝关节置换术在治疗局限于内侧或外侧间室的退行性关节炎患者中的成本效益。

方法

创建了一个用于治疗终末期单髁膝关节关节炎的决策模型。通过文献综述确定单髁或全膝关节置换术后可能的结果及其概率。使用效用因子对每个结果进行生活质量加权，有效性以质量调整生命年为单位表示。根据相关现行程序术语和诊断相关分组代码的医疗保险报销数据估算总成本。

结果

敏感性分析表明，单髁膝关节置换术的成本效益取决于其耐用性和功能结果接近全膝关节置换术的假设。具体而言，单髁植入物的生存率必须在假设的全膝关节植入物生存率的三到四年内，单髁置换术才能仍然是一种具有成本效益的替代方案。在这些假设下，使用单髁置换术是一种具有成本效益的选择，因为它以每获得一个质量调整生命年低于50,000美元（1998年美元）的成本带来有效性的增量收益。