Squitieri Lee, Chung Kevin C, Hutton David W, Burns Patricia B, Kim H Myra, Mahmoudi Elham
Los Angeles, Calif.; and Ann Arbor, Mich. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California; the Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles; the Department of Surgery, Section of Plastic Surgery, and the Center for Statistical Consultation and Research, University of Michigan; and the Section of Plastic Surgery, University of Michigan Medical School.
Plast Reconstr Surg. 2015 Aug;136(2):305-314. doi: 10.1097/PRS.0000000000001409.
There is a paucity of research evaluating the cost-effectiveness of surgical interventions for rheumatoid arthritis patients. Previous reports have challenged the sustainability of improved outcomes after silicone metacarpophalangeal arthroplasty. The authors conducted an economic evaluation of the long-term health outcomes after silicone metacarpophalangeal arthroplasty.
The authors performed a 5-year prospective cohort study of 170 patients with rheumatoid arthritis (73 surgical and 97 nonsurgical). Objective functional measurements and patient-rated outcomes using the Michigan Hand Outcomes Questionnaire and the Arthritis Impact Measurement Scale 2 were collected at 3 and 5 years. A cost-effectiveness analysis using direct costs from Medicare outpatient claims data (2006 to 2010) was performed to estimate the incremental cost-effectiveness ratios for both the Michigan and Arthritis Impact Measurement Scale 2 measurements.
At 5 years, the authors observed a statistically significant difference in upper extremity outcomes (Michigan Hand Outcomes Questionnaire) between the two groups, with surgical patients having higher outcomes. Costs associated with improved outcomes 5 years after surgery were $787 to $1150 when measured by the Michigan Hand Outcomes Questionnaire and $49,843 to $149,530 when measured by the Arthritis Impact scale. The incremental cost-effectiveness ratios did not substantially increase with their observed surgical revision rate of 5.5 percent (approximately 4 percent increase in incremental cost-effectiveness ratio) or with previously published long-term revision rates of 6.2 percent (approximately 6 percent increase in incremental cost-effectiveness ratio).
Short-term improvements in upper extremity outcomes after silicone metacarpophalangeal arthroplasty are maintained over the 5-year follow-up period. These outcomes are achieved at a relatively low cost, even with the addition of potential surgical complications.
评估类风湿性关节炎患者手术干预成本效益的研究较少。先前的报告对硅胶掌指关节置换术后改善疗效的可持续性提出了质疑。作者对硅胶掌指关节置换术后的长期健康结局进行了经济评估。
作者对170例类风湿性关节炎患者（73例手术治疗，97例非手术治疗）进行了为期5年的前瞻性队列研究。在3年和5年时收集使用密歇根手部结局问卷和关节炎影响测量量表2的客观功能测量结果和患者自评结局。利用医疗保险门诊理赔数据（2006年至2010年）中的直接成本进行成本效益分析，以估计密歇根量表和关节炎影响测量量表2测量结果的增量成本效益比。
在5年时，作者观察到两组在上肢结局（密歇根手部结局问卷）方面存在统计学上的显著差异，手术患者的结局更好。手术后5年与改善结局相关的成本，以密歇根手部结局问卷衡量为787美元至1150美元，以关节炎影响量表衡量为49843美元至149530美元。观察到的手术翻修率为5.5%（增量成本效益比增加约4%）或先前公布的长期翻修率为6.2%（增量成本效益比增加约6%）时，增量成本效益比并未大幅增加。
硅胶掌指关节置换术后上肢结局的短期改善在5年随访期内得以维持。即使加上潜在的手术并发症，这些结局也是以相对较低的成本实现的。
