Jacobson J J, Schweitzer S O, Kowalski C J
University of Michigan School of Dentistry, Ann Arbor.
Oral Surg Oral Med Oral Pathol. 1991 Aug;72(2):167-77. doi: 10.1016/0030-4220(91)90159-a.
A decision-analytic model and a cost effectiveness analysis was performed on 1 million hypothetic prosthetic joint patients undergoing dental treatment, to determine the most cost-effective strategy to prevent late prosthetic joint infections. The cost per quality-adjusted life-year saved (QALY) was determined for three preventive strategies: no prophylaxis, oral penicillin, and oral cephalexin. The UCLA Pain-Walking-Function-Activity Scale was used to obtain quality-of-life adjustments (utility assessment) for the study population. Costs were derived from 70 patients hospitalized between July 1, 1982, and June 30, 1986, at the UCLA Center for Health Sciences. The most cost-effective preventive strategy was the no prophylaxis alternative ($196,500/QALY). However, by recommending a 1-day strategy of oral cephalexin only to those dental patients at high risk for late prosthetic joint infections rather than a 3-day regimen to all patients, the cost effectiveness improved from $1.1 million/QALY to $446,100/QALY while maintaining a low risk of death (0.38 deaths per 10(6) dental visits).
对100万接受牙科治疗的假关节患者进行了决策分析模型和成本效益分析，以确定预防晚期假关节感染的最具成本效益的策略。针对三种预防策略确定了每挽救一个质量调整生命年（QALY）的成本：不进行预防、口服青霉素和口服头孢氨苄。使用加州大学洛杉矶分校疼痛-行走-功能-活动量表来获得研究人群的生活质量调整（效用评估）。成本来自1982年7月1日至1986年6月30日期间在加州大学洛杉矶分校健康科学中心住院的70名患者。最具成本效益的预防策略是不进行预防的方案（196,500美元/QALY）。然而，通过仅向那些晚期假关节感染高风险的牙科患者推荐为期1天的口服头孢氨苄策略，而不是对所有患者采用为期3天的治疗方案，成本效益从110万美元/QALY提高到446,100美元/QALY，同时保持较低的死亡风险（每10^6次牙科就诊0.38例死亡）。
