Abbott J Haxby, Usiskin Ilana M, Wilson Ross, Hansen Paul, Losina Elena
Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America.
PLoS One. 2017 Oct 24;12(10):e0185676. doi: 10.1371/journal.pone.0185676. eCollection 2017.
Knee osteoarthritis is a leading global cause of health-related quality of life loss. The aim of this project was to quantify health losses arising from knee osteoarthritis in New Zealand (NZ) in terms of quality-adjusted life years (QALYs) lost.
The Osteoarthritis Policy Model (OAPol), a validated Monte Carlo computer simulation model, was used to estimate QALYs lost due to knee osteoarthritis in the NZ adult population aged 40-84 over their lifetimes from the base year of 2006 until death. Data were from the NZ Health Survey, NZ Burden of Diseases, NZ Census, and relevant literature. QALYs were derived from NZ EQ-5D value set 2. Sensitivity to health state valuation, disease and pain prevalence were assessed in secondary analyses.
Based on NZ EQ-5D health state valuations, mean health losses due to knee osteoarthritis over people's lifetimes in NZ are 3.44 QALYs per person, corresponding to 467,240 QALYs across the adult population. Average estimated per person QALY losses are higher for non-Māori females (3.55) than Māori females (3.38), and higher for non-Māori males (3.34) than Māori males (2.60). The proportion of QALYs lost out of the total quality-adjusted life expectancy for those without knee osteoarthritis is similar across all subgroups, ranging from 20 to 23 percent.
At both the individual and population levels, knee osteoarthritis is responsible for large lifetime QALY losses. QALY losses are higher for females than males due to greater prevalence of knee osteoarthritis and higher life expectancy, and lower for Māori than non-Māori due to lower life expectancy. Large health gains are potentially realisable from public health and policy measures aimed at decreasing incidence, progression, pain, and disability of osteoarthritis.
膝关节骨关节炎是导致全球与健康相关的生活质量下降的主要原因。本项目的目的是根据损失的质量调整生命年（QALY）来量化新西兰（NZ）膝关节骨关节炎所造成的健康损失。
采用经过验证的蒙特卡洛计算机模拟模型——骨关节炎政策模型（OAPol），来估计2006年基准年至死亡期间，新西兰40 - 84岁成年人群因膝关节骨关节炎在其一生中损失的QALY。数据来源于新西兰健康调查、新西兰疾病负担、新西兰人口普查以及相关文献。QALY源自新西兰EQ - 5D价值集2。在二次分析中评估了对健康状态估值、疾病和疼痛患病率的敏感性。
根据新西兰EQ - 5D健康状态估值，新西兰人群一生中因膝关节骨关节炎导致的平均健康损失为每人3.44个QALY，成年人群总计467,240个QALY。非毛利女性的人均QALY损失估计值（3.55）高于毛利女性（3.38），非毛利男性（3.34）高于毛利男性（2.60）。在所有亚组中，无膝关节骨关节炎者的总质量调整预期寿命中损失的QALY比例相似，范围在20%至23%之间。
在个体和人群层面，膝关节骨关节炎都会导致大量的终生QALY损失。由于膝关节骨关节炎患病率较高和预期寿命较长，女性的QALY损失高于男性；由于预期寿命较低，毛利人的QALY损失低于非毛利人。旨在降低骨关节炎发病率、进展、疼痛和残疾程度的公共卫生和政策措施有可能带来巨大的健康收益。
