University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada; Arthritis Research Canada, Richmond, Canada.
University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada.
Osteoarthritis Cartilage. 2017 Oct;25(10):1615-1622. doi: 10.1016/j.joca.2017.05.022. Epub 2017 Jun 15.
Shared decision-making (SDM) is a key priority to improve patient-centred care, and can play an important role in helping patients decide whether to undergo total joint arthroplasty (TJA). Patient decision aids can support SDM; however, they may incur an upfront cost. We aimed to estimate the health and economic effects of patient decision aids for TJA.
A cost-effectiveness analysis of a randomised controlled trial (RCT) with 2-year follow-up. 343 patients were recruited from two orthopedic screening clinics in Ottawa, Canada. Patients were randomized to either a patient decision aid plus surgeon preference report (decision aid) or usual care. Primary outcomes were costs (in 2014 CAD$), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Costs were calculated by multiplying self-reported resource use by unit costs. QALYs were calculated by mapping the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to EuroQol 5-Dimension (EQ-5D) health utilities. Costs and QALYs were discounted at 5%. Multiple imputation was used to handle missing data, and bootstrapping was used to estimate uncertainty.
The sample comprised 167 intervention and 167 control group patients. The decision aid arm had fewer surgeries over the 2-year period thereby incurring a negative incremental cost of -$560 (95% CI: -$1358 to $426) per patient while providing 0.05 (95% CI: -0.04 to 0.13) additional QALYs per patient. Consequently, the decision aid arm was dominant.
The use of a patient decision aid was associated with fewer health care costs, while producing similar health outcomes.
CT00911638 (clinicaltrials.gov).
共同决策（SDM）是改善以患者为中心的护理的关键重点，并且可以在帮助患者决定是否进行全关节置换术（TJA）方面发挥重要作用。患者决策辅助工具可以支持 SDM；但是，它们可能会产生前期成本。我们旨在评估 TJA 患者决策辅助工具的健康和经济影响。
这是一项具有 2 年随访的随机对照试验（RCT）的成本效益分析。343 名患者从加拿大渥太华的两个骨科筛查诊所招募。患者被随机分配到患者决策辅助工具加外科医生偏好报告（决策辅助工具）或常规护理组。主要结果是成本（2014 年加元）、质量调整生命年（QALY）和增量成本效益比（ICER）。成本通过乘以自我报告的资源使用乘以单位成本来计算。QALYs 通过将西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）映射到欧洲五维健康量表（EQ-5D）健康效用来计算。成本和 QALYs 以 5%贴现。使用多重插补处理缺失数据，使用自举法估计不确定性。
该样本包括 167 名干预组和 167 名对照组患者。在 2 年期间，决策辅助组的手术次数较少，因此每位患者的增量成本为负$560（95%CI：-$1358 至$426），而每位患者提供的额外 QALY 为 0.05（95%CI：-0.04 至 0.13）。因此，决策辅助工具组具有优势。
使用患者决策辅助工具与较低的医疗保健成本相关，同时产生相似的健康结果。
CT00911638（clinicaltrials.gov）。
