Osterhoff Georg, O'Hara Nathan N, D'Cruz Jennifer, Sprague Sheila A, Bansback Nick, Evaniew Nathan, Slobogean Gerard P
Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Orthopaedics, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Value Health. 2017 Mar;20(3):404-411. doi: 10.1016/j.jval.2016.10.017. Epub 2016 Dec 12.
There is ongoing debate regarding the optimal surgical treatment of complex proximal humeral fractures in elderly patients.
To evaluate the cost-effectiveness of reverse total shoulder arthroplasty (RTSA) compared with hemiarthroplasty (HA) in the management of complex proximal humeral fractures, using a cost-utility analysis.
On the basis of data from published literature, a cost-utility analysis was conducted using decision tree and Markov modeling. A single-payer perspective, with a willingness-to-pay (WTP) threshold of Can$50,000 (Canadian dollars), and a lifetime time horizon were used. The incremental cost-effectiveness ratio (ICER) was used as the study's primary outcome measure.
In comparison with HA, the incremental cost per quality-adjusted life-year gained for RTSA was Can$13,679. One-way sensitivity analysis revealed the model to be sensitive to the RTSA implant cost and the RTSA procedural cost. The ICER of Can$13,679 is well below the WTP threshold of Can$50,000, and probabilistic sensitivity analysis demonstrated that 92.6% of model simulations favored RTSA.
Our economic analysis found that RTSA for the treatment of complex proximal humeral fractures in the elderly is the preferred economic strategy when compared with HA. The ICER of RTSA is well below standard WTP thresholds, and its estimate of cost-effectiveness is similar to other highly successful orthopedic strategies such as total hip arthroplasty for the treatment of hip arthritis.
关于老年患者复杂肱骨近端骨折的最佳手术治疗方法，目前仍存在争议。
采用成本效用分析，评估在复杂肱骨近端骨折治疗中，反式全肩关节置换术（RTSA）与半肩关节置换术（HA）相比的成本效益。
基于已发表文献的数据，使用决策树和马尔可夫模型进行成本效用分析。采用单一支付方视角，支付意愿（WTP）阈值为50,000加元，时间范围为终身。增量成本效益比（ICER）用作研究的主要结局指标。
与HA相比，RTSA每获得一个质量调整生命年的增量成本为13,679加元。单向敏感性分析显示该模型对RTSA植入物成本和RTSA手术成本敏感。13,679加元的ICER远低于50,000加元的WTP阈值，概率敏感性分析表明92.6%的模型模拟支持RTSA。
我们的经济分析发现，与HA相比，RTSA治疗老年复杂肱骨近端骨折是更优的经济策略。RTSA的ICER远低于标准WTP阈值，其成本效益估计与其他非常成功的骨科策略（如治疗髋关节炎的全髋关节置换术）相似。
