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关节镜下半月板切除术治疗退行性半月板撕裂可减轻膝关节疼痛,但在常规医疗保健环境中不具有成本效益:一项多中心纵向观察研究,使用来自骨关节炎倡议的数据。

Arthroscopic meniscectomy for degenerative meniscal tears reduces knee pain but is not cost-effective in a routine health care setting: a multi-center longitudinal observational study using data from the osteoarthritis initiative.

机构信息

Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Operating Rooms, Nijmegen, The Netherlands.

Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Operating Rooms, Nijmegen, The Netherlands.

出版信息

Osteoarthritis Cartilage. 2018 Feb;26(2):184-194. doi: 10.1016/j.joca.2017.02.805. Epub 2017 Sep 10.

Abstract

OBJECTIVES

It is disputed whether arthroscopic meniscectomy is an (cost-) effective treatment for degenerative meniscus tears in day-to-day clinical practice. The objective of this study was to assess the cost-effectiveness of arthroscopic meniscectomy in subjects with knee osteoarthritis, in routine clinical practice, while taking into account the increased risk for future knee replacement surgery. We compared cost-effectiveness of arthroscopic meniscectomy compared to no surgery.

DESIGN

We used a state transition (Markov) simulation model to evaluate the cost-effectiveness of arthroscopic meniscectomy compared to no surgery in subjects with knee osteoarthritis (age range 45-79 years). Data used in the preparation of the current study were obtained from the Osteoarthritis Initiative (AOI) database. We applied a 9 years' time horizon (which is equal to the current OAI study follow up period), and evaluated cost-effectiveness from a societal perspective. The main outcome measure was the incremental cost-effectiveness ratio (Euros per quality adjusted life-year (QALY) gained).

RESULTS

Arthroscopic meniscectomy was associated with 8.09 (SD ± 0.07) QALYs at a cost of € 21,345 (SD ± 841), whereas the no surgery was associated with 8.05 (SD ± 0.07) QALYs at a cost of € 16,284 (SD ± 855). For arthroscopic meniscectomy, the incremental cost per QALY gained was € 150,754.

CONCLUSIONS

In day-to-day clinical practice, arthroscopic meniscectomy in subjects with knee osteoarthritis is associated with € 150,754 per QALY gained, which exceeds the generally accepted willingness to pay (WTP) (range € 20,000-€ 80,000).

摘要

目的

在日常临床实践中,关节镜半月板切除术是否是退行性半月板撕裂的(成本)有效治疗方法存在争议。本研究的目的是评估关节镜半月板切除术在膝关节骨关节炎患者中的成本效益,同时考虑到未来膝关节置换手术的风险增加。我们将关节镜半月板切除术与不手术进行了成本效益比较。

设计

我们使用状态转换(马尔可夫)仿真模型来评估膝关节骨关节炎患者(年龄在 45-79 岁之间)中关节镜半月板切除术与不手术相比的成本效益。本研究中使用的数据来自骨关节炎倡议(OAI)数据库。我们采用了 9 年的时间范围(与当前 OAI 研究的随访期相同),并从社会角度评估了成本效益。主要观察指标是增量成本效益比(每获得一个质量调整生命年的欧元成本)。

结果

关节镜半月板切除术的成本为 21,345 欧元(标准差±0.07),与 8.09 个(标准差±0.07)QALYs 相关,而不手术的成本为 16,284 欧元(标准差±0.08),与 8.05 个(标准差±0.07)QALYs 相关。对于关节镜半月板切除术,每获得一个 QALY 的增量成本为 150,754 欧元。

结论

在日常临床实践中,膝关节骨关节炎患者的关节镜半月板切除术与每获得一个 QALY 的成本为 150,754 欧元,超过了普遍接受的支付意愿(WTP)(范围为 20,000-80,000 欧元)。

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