Tarride J E, Hopkins R B, Blackhouse G, Burke N, Bhandari M, Johal H, Guyatt G H, Busse J W
McMaster University, and Member, Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, 43 Charlton Ave. East, 2nd Floor, Hamilton, Ontario, L8N 1Y3, Canada.
McMaster University, 293 Wellington St. North, Suite 110, Hamilton, Ontario, L8L 8E7, Canada.
Bone Joint J. 2017 Nov;99-B(11):1526-1532. doi: 10.1302/0301-620X.99B11.BJJ-2017-0737.
This 501-patient, multi-centre, randomised controlled trial sought to establish the effect of low-intensity, pulsed, ultrasound (LIPUS) on tibial shaft fractures managed with intramedullary nailing. We conducted an economic evaluation as part of this trial.
Data for patients' use of post-operative healthcare resources and time taken to return to work were collected and costed using publicly available sources. Health-related quality of life, assessed using the Health Utilities Index Mark-3 (HUI-3), was used to derive quality-adjusted life years (QALYs). Costs and QALYs were compared between LIPUS and control (a placebo device) from a payer and societal perspective using non-parametric bootstrapping. All costs are reported in 2015 Canadian dollars unless otherwise stated.
With a cost per device of $3,995, the mean cost was significantly higher for patients treated with LIPUS placebo from a payer (mean increase = $3647, 95% confidence interval (CI) $3244 to $4070; p < 0.001) or a societal perspective (mean increase = $3425, 95% CI $1568 to $5283; p < 0.001). LIPUS did not provide a significant benefit in terms of QALYs gained (mean difference = 0.023 QALYs, 95% CI -0.035 to 0.069; p = 0.474). Incremental cost-effectiveness ratios of LIPUS compared with placebo were $155 433/QALY from a payer perspective and $146 006/QALY from a societal perspective.
At the current price, LIPUS is not cost-effective for fresh tibial fractures managed with intramedullary nailing. Cite this article: 2017;99-B:1526-32.
这项纳入501例患者的多中心随机对照试验旨在确定低强度脉冲超声（LIPUS）对采用髓内钉治疗的胫骨干骨折的影响。作为该试验的一部分，我们进行了一项经济学评估。
收集患者术后医疗资源使用情况及恢复工作所需时间的数据，并利用公开可用资源进行成本核算。使用健康效用指数Mark-3（HUI-3）评估的健康相关生活质量用于得出质量调整生命年（QALY）。从支付方和社会角度，采用非参数自举法比较LIPUS组与对照组（一种安慰剂装置）的成本和QALY。除非另有说明，所有成本均以2015年加拿大元报告。
LIPUS装置每台成本为3995美元，从支付方角度（平均增加3647美元，95%置信区间（CI）为3244美元至4070美元；p<0.001）或社会角度（平均增加3425美元，95%CI为1568美元至5283美元；p<0.001）来看，接受LIPUS治疗的患者平均成本显著高于接受安慰剂治疗的患者。在获得的QALY方面，LIPUS未显示出显著益处（平均差异=0.023 QALY，95%CI为-0.035至0.069；p=0.474）。与安慰剂相比，LIPUS从支付方角度的增量成本效益比为155433美元/QALY，从社会角度为146006美元/QALY。
以当前价格，LIPUS对于采用髓内钉治疗的新鲜胫骨骨折不具有成本效益。引用本文：2017；99-B：1526 - 32。
