Institute of Health Service Research, University of Exeter Medical School, University of Exeter, Exeter, UK.
Value Health. 2013 Mar-Apr;16(2):267-79. doi: 10.1016/j.jval.2012.10.020. Epub 2013 Jan 26.
To assess the cost-effectiveness of early primary total hip replacement (THR) for functionally independent older adult patients with osteoarthritis (OA) versus 1) nonsurgical therapy followed by THR once the patient has progressed to a functionally dependent state ("delayed THR") and 2) nonsurgical therapy alone ('medical therapy'), from the Italian National Health Service perspective.
Individual patient data and evidence from published literature on disease progression, economic costs and THR outcomes in OA, including utilities, perioperative mortality rates, prosthesis survival, and costs of prostheses, THR, rehabilitation, follow-up, revision, and nonsurgical management, combined with population life tables, were synthesized in a Markov model of OA. The model represents the lifetime experience of a patient cohort following their treatment choice, discounting costs and benefits (quality-adjusted life-years) at 3% annually.
At age 65 years, the incremental cost per quality-adjusted life-year of THR over delayed THR was €987 in men and €466 in women; the figures for delayed THR versus medical therapy were €463 and €82, respectively. Among 80-year-olds, early THR is (extended) dominant. With gradual utility loss after primary THR, delaying surgery may be more appealing in women than in men in their 50s, because longer female life expectancy implies longer latter periods of low health-related quality of life (HRQOL) with early THR.
THR is cost-effective. Patients' HRQOL benefits forgone with delayed THR are worth more than the costs it saves to the Italian National Health Service. This analysis might help to explain women's consistently lower HRQOL by the time of primary operation.
从意大利国家卫生服务体系的角度出发，评估对于功能独立的老年骨关节炎（OA）患者，行早期初次全髋关节置换术（THR）与 1）患者功能下降后行 THR（“延迟 THR”）和 2）单纯非手术治疗（“药物治疗”）相比的成本效益。
从发表的 OA 疾病进展、经济成本和 THR 结果的文献中提取个体患者数据和证据，包括效用、围手术期死亡率、假体生存率和假体、THR、康复、随访、翻修和非手术治疗的成本，结合人群生命表，综合在 OA 的 Markov 模型中。该模型代表了患者队列在治疗选择后的终生经历，每年按 3%折现成本和效益（质量调整生命年）。
在 65 岁时，男性 THR 相对于延迟 THR 的增量成本效益为每质量调整生命年 987 欧元，女性为 466 欧元；而延迟 THR 相对于药物治疗的增量成本效益为每质量调整生命年 463 欧元和 82 欧元。在 80 岁时，早期 THR 具有优势（延长）。由于女性预期寿命较长，初次 THR 后随着效用逐渐下降，延迟手术对女性的吸引力可能大于男性，因为这意味着她们的后期低健康相关生活质量（HRQOL）的时间更长。
THR 具有成本效益。延迟 THR 所放弃的患者 HRQOL 获益，比其为意大利国家卫生服务体系节省的成本更有价值。这种分析可能有助于解释女性在初次手术时 HRQOL 持续较低的原因。
