Schilling Chris G, Dowsey Michelle M, Petrie Dennis J, Clarke Philip M, Choong Peter F
Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria; Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria.
Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria; Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria.
J Arthroplasty. 2017 Feb;32(2):395-401.e2. doi: 10.1016/j.arth.2016.07.036. Epub 2016 Aug 10.
We investigated the predictors of long-term gains in quality-adjusted life years (QALYs) from total knee arthroplasty (TKA) and the patient attributes that predicted cost-effective TKA.
Data on TKA patients (n = 570) from 2006 to 2007 were extracted from a single-institution registry. QALY gains over 7 years post surgery were calculated from health-related quality of life (HrQoL) scores measured preoperatively and annually postoperatively using the short-form health survey (SF-12) instrument. Multivariate linear regression analysis investigated the predictors of QALY gain from TKA from a broad range of preoperative patient characteristics and was used to predict QALY gains for each individual. Patients were grouped into deciles according to their predicted QALY gain, and the cost-effectiveness of each decile was plotted on the cost-effectiveness plane. Patient attribute differences between deciles were decomposed.
After exclusions and dropout, data were available for 488 patients. The average estimated QALY gain over 7 years was 0.77 (95% confidence interval [CI] 0.70-0.83). Predictors significantly associated with smaller QALY gains were comorbidities (Charlson comorbidity index 3+ coefficient -0.54 CI -0.15 to -0.92), the absence of severe osteoarthritis in the ipsilateral knee (-0.51 CI -0.16 to -0.85), preoperative HrQoL (standardized coefficient -0.34 CI -0.26 to -0.43), the requirement for an interpreter (-0.24 CI -0.05 to -0.44), and age (-0.01 CI -0.01 to -0.02). The largest difference between cost-effective and non-cost-effective deciles was relatively high preoperative HrQoL in the non-cost-effective decile.
TKA is likely to be cost-effective for most patients except those with unusually high preoperative HrQoL or a lack of severe osteoarthritis. The poorer outcomes for those requiring an interpreter requires further research.
我们研究了全膝关节置换术（TKA）后质量调整生命年（QALY）长期获益的预测因素以及预测TKA成本效益的患者特征。
从一个单机构登记处提取2006年至2007年TKA患者（n = 570）的数据。术后7年的QALY获益通过使用简短健康调查问卷（SF - 12）工具术前及术后每年测量的健康相关生活质量（HrQoL）得分来计算。多变量线性回归分析从广泛的术前患者特征中研究了TKA后QALY获益的预测因素，并用于预测每个个体的QALY获益。根据预测的QALY获益将患者分为十分位数组，并将每个十分位数组的成本效益绘制在成本效益平面上。分解十分位数组之间的患者特征差异。
排除和失访后，有488例患者的数据可用。7年的平均估计QALY获益为0.77（95％置信区间[CI] 0.70 - 0.83）。与较小QALY获益显著相关的预测因素为合并症（Charlson合并症指数3+系数 - 0.54，CI - 0.15至 - 0.92）、同侧膝关节无重度骨关节炎（-0.51，CI - 0.16至 - 0.85）、术前HrQoL（标准化系数 - 0.34，CI - 0.26至 - 0.43）、需要翻译（-0.24，CI - 0.05至 - 0.44）和年龄（-0.01，CI - 0.01至 - 0.02）。成本效益高和成本效益低的十分位数组之间最大的差异是成本效益低的十分位数组术前HrQoL相对较高。
除术前HrQoL异常高或缺乏重度骨关节炎的患者外，TKA对大多数患者可能具有成本效益。对于需要翻译的患者较差的结局需要进一步研究。
