双排关节镜下肩袖修补术比单排修补术更具成本效益。
Double-Row Arthroscopic Rotator Cuff Repair Is More Cost-Effective Than Single-Row Repair.
作者信息
Huang Adrian L, Thavorn Kednapa, van Katwyk Sasha, MacDonald Peter, Lapner Peter
机构信息
1Division of Orthopedics (A.L.H. and P.L.) and Clinical Epidemiology Program (K.T. and S.v.K.), Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada 2School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada 3Institute of Clinical and Evaluative Sciences, Ottawa, Ontario, Canada 4Section of Orthopaedic Surgery and the Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada.
出版信息
J Bone Joint Surg Am. 2017 Oct 18;99(20):1730-1736. doi: 10.2106/JBJS.16.01044.
BACKGROUND
The optimal technique for arthroscopic rotator cuff repair is controversial, and both single and double-row techniques are commonly used. In the current era of increasing costs, health-care delivery models are focusing on the value of care. In this study, we compared the cost-effectiveness of single-row and double-row reconstructions in patients undergoing arthroscopic rotator cuff repair.
METHODS
A cost-utility analysis was performed from the perspective of a publicly funded health-care system. Health-care costs, probabilities, and utility values were derived from the published literature. Efficacy data were obtained from a previous randomized controlled trial comparing the effect of single-row (n = 48) or double-row (n = 42) reconstruction among 90 surgical patients. Unit cost data were obtained from a hospital database and the Ontario Schedule of Benefits and Fees. Results are presented as an incremental cost per quality-adjusted life year (QALY) gained. All costs are presented in 2015 Canadian dollars. A series of 1-way and probabilistic sensitivity analyses were performed.
RESULTS
Double-row fixation was more costly ($2,134.41 compared with $1,654.76) but was more effective than the single-row method (4.073 compared with 4.055 QALYs). An incremental cost-effectiveness ratio (ICER) was estimated to be $26,666.75 per QALY gained for double-row relative to single-row fixation. A subgroup analysis demonstrated that patients with larger rotator cuff tears (≥3 cm) had a lower ICER, suggesting that double-row fixation may be more cost-effective for larger tears.
CONCLUSIONS
Based on the willingness-to-pay threshold of $50,000 per QALY gained, double-row fixation was found to be more cost-effective than single-row. Furthermore, a double-row reconstruction was found to be more economically attractive for larger rotator cuff tears (≥3 cm).
LEVEL OF EVIDENCE
Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
关节镜下肩袖修复的最佳技术存在争议，单排和双排技术都普遍使用。在当前成本不断增加的时代，医疗服务模式正关注医疗价值。在本研究中，我们比较了接受关节镜下肩袖修复患者的单排和双排重建的成本效益。
方法
从公共资助的医疗系统角度进行成本效用分析。医疗成本、概率和效用值来自已发表的文献。疗效数据来自先前一项随机对照试验，该试验比较了90例手术患者中单排（n = 48）或双排（n = 42）重建的效果。单位成本数据来自医院数据库和安大略省福利与费用表。结果以每获得一个质量调整生命年（QALY）的增量成本表示。所有成本均以2015年加拿大元呈现。进行了一系列单因素和概率敏感性分析。
结果
双排固定成本更高（2134.41美元，而单排为1654.76美元），但比单排方法更有效（4.073个QALY，而单排为4.055个QALY）。相对于单排固定，双排固定每获得一个QALY的增量成本效益比（ICER）估计为26,666.75美元。亚组分析表明，肩袖撕裂较大（≥3 cm）的患者ICER较低，这表明双排固定对于较大撕裂可能更具成本效益。
结论
基于每获得一个QALY支付意愿阈值为50,000美元，发现双排固定比单排更具成本效益。此外，对于较大的肩袖撕裂（≥3 cm），双排重建在经济上更具吸引力。
证据水平
经济与决策分析IV级。有关证据水平的完整描述，请参阅作者指南。
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