Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320-W, San Francisco, CA 94143, USA.
Clin Orthop Relat Res. 2012 Apr;470(4):1079-89. doi: 10.1007/s11999-011-2023-7.
The impact of hip arthroscopy on health-related quality of life (HRQoL) among younger patients with symptomatic femoroacetabular impingement (FAI) is unknown, but with increasing recognition of the condition there is likely to be increasing demand for arthroscopy.
QUESTIONS/PURPOSES: We describe an approach to determine the incremental cost-effectiveness of hip arthroscopy compared with observation in patients with FAI; we also identified variables that influence its cost-effectiveness.
We constructed a Markov model including possible health states for 36-year-old patients with FAI using decision analysis software and compared two strategies: (1) observation and (2) hip arthroscopy, followed by THA with disease progression. We estimated the ratio of the incremental cost to the incremental benefit (reflected by HRQoL) of both strategies. We identified studies reporting Harris hip scores and complications after arthroscopy to estimate health state preferences and their probabilities. We performed sensitivity analyses on 30 input variables over a plausible range of estimates to determine the influence of uncertainty on the ICER with particular emphasis on the magnitude and duration of benefit.
Among patients with FAI but no radiographic evidence of arthritis, the estimated ICER of hip arthroscopy was $21,700/QALY while the ICER for patients with preoperative arthritis was $79,500/QALY. Alteration of the natural history of arthritis by hip arthroscopy improved the ICER to $19,200/QALY and resulted in cost savings if THA was not performed until at least 16 years after arthroscopy.
Although limited by available data, our model suggests hip arthroscopy in patients with FAI without arthritis may result in a favorable ICER compared with other health interventions considered cost-effective. Further studies of hip arthroscopy are needed to determine the impact on quality of life, duration of symptomatic relief, and the effect on the need for subsequent THA.
髋关节镜手术对患有症状性股骨髋臼撞击症（FAI）的年轻患者的健康相关生活质量（HRQoL）的影响尚不清楚，但随着对该病认识的提高，髋关节镜手术的需求可能会增加。
问题/目的：我们描述了一种确定髋关节镜手术与观察治疗 FAI 患者的增量成本效益的方法；我们还确定了影响其成本效益的变量。
我们使用决策分析软件为 36 岁患有 FAI 的患者构建了一个包含可能健康状态的马尔可夫模型，并比较了两种策略：（1）观察和（2）髋关节镜检查，然后在疾病进展时进行 THA。我们估计了两种策略的增量成本与增量效益（反映在 HRQoL 上）的比率。我们确定了报告髋关节镜手术后 Harris 髋关节评分和并发症的研究，以估计健康状态偏好及其概率。我们对 30 个输入变量进行了敏感性分析，以确定不确定性对 ICER 的影响，特别是对效益的幅度和持续时间的影响。
在没有放射学关节炎证据的 FAI 患者中，髋关节镜手术的估计增量成本效益比为 21,700/QALY，而术前关节炎患者的增量成本效益比为 79,500/QALY。髋关节镜手术改变关节炎的自然病史可将 ICER 提高至 19,200/QALY，如果直到髋关节镜手术后至少 16 年才进行 THA，则可节省成本。
尽管受到现有数据的限制，但我们的模型表明，对于没有关节炎的 FAI 患者，髋关节镜手术可能会产生比其他被认为具有成本效益的健康干预措施更有利的 ICER。需要进一步研究髋关节镜手术，以确定其对生活质量、症状缓解持续时间的影响以及对后续 THA 需求的影响。
