Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, England.
BMC Musculoskelet Disord. 2014 Jan 18;15:22. doi: 10.1186/1471-2474-15-22.
The projected demand for total knee arthroplasty is staggering. At its root, the solution involves increasing supply or decreasing demand. Other developed nations have used rationing and wait times to distribute this service. However, economic impact and cost-effectiveness of waiting for TKA is unknown.
A Markov decision model was constructed for a cost-utility analysis of three treatment strategies for end-stage knee osteoarthritis: 1) TKA without delay, 2) a waiting period with no non-operative treatment and 3) a non-operative treatment bridge during that waiting period in a cohort of 60 year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective with national average Medicare reimbursement. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, effectiveness, and quality-adjusted life years; and net health benefits.
In the base case, a 2-year wait-time both with and without a non-operative treatment bridge resulted in a lower number of average QALYs gained (11.57 (no bridge) and 11.95 (bridge) vs. 12.14 (no delay). The average cost was $1,660 higher for TKA without delay than wait-time with no bridge, but $1,810 less than wait-time with non-operative bridge. The incremental cost-effectiveness ratio comparing wait-time with no bridge to TKA without delay was $2,901/QALY. When comparing TKA without delay to waiting with non-operative bridge, TKA without delay produced greater utility at a lower cost to society.
TKA without delay is the preferred cost-effective treatment strategy when compared to a waiting for TKA without non-operative bridge. TKA without delay is cost saving when a non-operative bridge is used during the waiting period. As it is unlikely that patients waiting for TKA would not receive non-operative treatment, TKA without delay may be an overall cost-saving health care delivery strategy. Policies aimed at increasing the supply of TKA should be considered as savings exist that could indirectly fund those strategies.
全膝关节置换术的需求量预计会很大。究其根本，解决办法包括增加供给或减少需求。其他发达国家已经使用配给制和等待时间来分配这项服务。然而，等待 TKA 的经济影响和成本效益尚不清楚。
为了对终末期膝骨关节炎的三种治疗策略进行成本效用分析，构建了一个马尔可夫决策模型：1）无延迟 TKA；2）无非手术治疗的等待期；3）在 60 岁患者队列的等待期间进行非手术治疗桥接。结果概率和效果来自文献。成本从社会角度用全国平均医疗保险报销来估计。效果以获得的质量调整生命年（QALY）表示。主要结果指标是平均增量成本、效果和质量调整生命年；以及净健康收益。
在基线情况下，等待 2 年时间，无论是有无非手术治疗桥接，都会导致平均获得的 QALY 数量较低（无桥接为 11.57，有桥接为 11.95，无延迟为 12.14）。与无桥接等待时间相比，无延迟 TKA 的平均成本高出 1660 美元，但比有非手术桥接等待时间的成本低 1810 美元。与无延迟 TKA 相比，无桥接等待时间的增量成本效益比为 2901 美元/QALY。当比较无延迟 TKA 与使用非手术桥接的等待时间时，无延迟 TKA 以较低的社会成本产生了更高的效用。
与无非手术桥接等待 TKA 相比，无延迟 TKA 是更具成本效益的治疗策略。当在等待期间使用非手术桥接时，无延迟 TKA 可节省成本。由于等待 TKA 的患者不太可能不接受非手术治疗，因此无延迟 TKA 可能是一种总体上节省成本的医疗保健提供策略。应考虑增加 TKA 供应的政策，因为存在节省的成本，可以间接为这些策略提供资金。
Zotero 插件
