Department of Experimental Medicine, Sapienza University of Rome, Italy.
J Surg Res. 2011 Aug;169(2):227-33. doi: 10.1016/j.jss.2009.10.031. Epub 2009 Nov 11.
The aim of the present study was to assess the cost-effectiveness of cement-less versus hybrid prostheses in total hip replacement (THR) in patients diagnosed with primary osteoarthritis.
Effectiveness data were obtained from the Emilia-Romagna Regional Registry on Orthopaedic Prosthesis (RIPO), which collects information on all orthopaedic intervention performed in Emilia-Romagna (41,199 total hip replacements performed from 2000 to 2007), and from which we obtained survival curves and transition probabilities for the cement-less and hybrid prostheses, respectively. Conversely, costs were derived from regional databases through a specific procedure, which allowed us to register individual component's costs for both primary and subsequent revision interventions. A specific Markov transition model was constructed in order to consider the 3 types of revisions that an implant could possibly undergo through its life-span: total, cup or stem, head insert or neck. The cost-effectiveness was expressed in terms of cost per "revision-free" life year.
Considering a 70-y old patient undergoing THR, the cementless strategy resulted more effective but more costly than the hybrid solution, with an incremental cost effectiveness ratio of 2401.63 € per revision-free life year. Following a deterministic sensitivity analysis, hybrid and cementless fixation showed, respectively, a dominance profile for patients older than 83 y and younger than 43 y, whereas for all ages in between, we report a progressive increase in the ICER of cementless prostheses. Our results proved to be robust, as underlined by the probabilistic sensitivity analysis performed using cost distributions.
本研究旨在评估初次诊断为原发性骨关节炎的患者在全髋关节置换术（THR）中使用非骨水泥型与混合假体的成本效果。
使用从 Emilia-Romagna 地区骨科假体注册处（RIPO）收集的有效性数据，该注册处收集了 Emilia-Romagna 地区所有骨科干预的数据（2000 年至 2007 年共进行了 41199 例全髋关节置换术），从中我们分别获得了非骨水泥型和混合假体的生存曲线和转移概率。相反，成本则通过特定程序从地区数据库中得出，该程序允许我们为初次和后续翻修干预分别登记单个组件的成本。构建了一个特定的马尔可夫转移模型，以考虑到植入物在其使用寿命内可能经历的 3 种翻修类型：全翻修、杯或柄、头插入物或颈。成本效果以每“无翻修”生命年的成本表示。
考虑到一位 70 岁的 THR 患者，非骨水泥策略比混合解决方案更有效，但更昂贵，无翻修生命年的增量成本效果比为 2401.63 欧元。进行确定性敏感性分析后，混合和非骨水泥固定分别显示，对于年龄大于 83 岁和小于 43 岁的患者具有优势，而对于年龄在两者之间的所有患者，我们报告了非骨水泥假体的 ICER 逐渐增加。概率敏感性分析使用成本分布证明了我们的结果是稳健的。
