Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, and the Department of Pediatrics and Communicable Diseases, University of Michigan Health System; and the Veterans Administration Health System.
Plast Reconstr Surg. 2014 Apr;133(4):827-840. doi: 10.1097/PRS.0000000000000019.
The purpose of this study was to perform a cost-utility analysis to compare revision amputation and replantation treatment of finger amputation injuries across a spectrum of injury scenarios.
The study was conducted from the societal perspective. Decision tree models were created for the reference case (two-finger amputation injury) and seven additional injury scenarios for comparison. Inputs included cost, quality of life, and probability of each health state. A Web-based time trade-off survey was created to determine quality-adjusted life-years for health states; 685 nationally representative adult community members were invited to participate in the survey. Overall cost and quality-adjusted life-years for revision amputation and replantation were calculated for each decision tree. An incremental cost-effectiveness ratio was calculated if a treatment was more costly but more effective.
The authors had a 64 percent response rate (n = 437). Replantation treatment had greater costs and quality-adjusted life-years compared with revision amputation in all injury scenarios. Replantation of single-digit injuries had the highest incremental cost-effectiveness ratio ($136,400 per quality-adjusted life-year gained). Replantation of three- and four-digit amputation injuries had relatively low cost-to-benefit ratios ($27,100 and $23,800 per quality-adjusted life-year, respectively). Replantation for distal thumb amputation had a relatively low incremental cost-effectiveness ratio ($26,300 per quality-adjusted life-year) compared with replantation of nonthumb distal amputations ($60,200 per quality-adjusted life-year).
The relative cost per quality-adjusted life-year gained with replantation treatment varied greatly among the injury scenarios. Situations in which indications for replantation are debated had higher cost per quality-adjusted life-year gained. This study highlights variability in value for replantation among different injury scenarios.
本研究旨在进行成本效用分析，比较手指离断伤在一系列损伤场景下的翻修截肢与再植治疗。
本研究从社会角度进行。为参考病例（两指离断伤）和另外七个损伤场景创建决策树模型以进行比较。输入包括成本、生活质量和每个健康状态的概率。创建了一个基于网络的时间权衡调查，以确定健康状态的调整后生命年；邀请了 685 名具有全国代表性的成年社区成员参与调查。为每个决策树计算了翻修截肢与再植的总费用和调整后生命年。如果一种治疗方法成本更高但效果更好，则计算增量成本效益比。
作者获得了 64%的响应率（n=437）。在所有损伤场景中，再植治疗的成本和调整后生命年均高于翻修截肢。单指损伤的再植具有最高的增量成本效益比（每获得一个质量调整生命年需花费 136400 美元）。三指和四指离断伤的再植具有相对较低的成本效益比（每获得一个质量调整生命年分别需花费 27100 美元和 23800 美元）。与非拇指远端截肢的再植相比（每获得一个质量调整生命年需花费 60200 美元），拇指远端离断伤的再植具有相对较低的增量成本效益比（每获得一个质量调整生命年需花费 26300 美元）。
再植治疗的每获得一个质量调整生命年的相对成本在不同损伤场景中差异很大。再植适应证存在争议的情况下，每获得一个质量调整生命年的成本更高。本研究突出了不同损伤场景下再植的价值存在差异。
