Orthopaedic and Arthritis Center for Outcomes Research Policy and Innovation Evaluation in Orthopaedic Treatments Center, Boston, Massachusetts.
Orthopaedic and Arthritis Center for Outcomes Research Policy and Innovation Evaluation in Orthopaedic Treatments Center, and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2018 Sep;70(9):1326-1334. doi: 10.1002/acr.23484. Epub 2018 Aug 16.
Total knee replacement (TKR) is an effective treatment for end-stage knee osteoarthritis (OA). American racial minorities undergo fewer TKRs than whites. We estimated quality-adjusted life-years (QALYs) lost for African American knee OA patients due to differences in TKR offer, acceptance, and complication rates.
We used the Osteoarthritis Policy Model, a computer simulation of knee OA, to predict QALY outcomes for African American and white knee OA patients with and without TKR. We estimated per-person QALYs gained from TKR as the difference between QALYs with current TKR use and QALYs when no TKR was performed. We estimated average, per-person QALY losses in African Americans as the difference between QALYs gained with white rates of TKR and QALYs gained with African American rates of TKR. We calculated population-level QALY losses by multiplying per-person QALY losses by the number of persons with advanced knee OA. Finally, we estimated QALYs lost specifically due to lower TKR offer and acceptance rates and higher rates of complications among African American knee OA patients.
African American men and women gain 64,100 QALYs from current TKR use. With white offer and complications rates, they would gain an additional 72,000 QALYs. Because these additional gains are unrealized, we call this a loss of 72,000 QALYs. African Americans lose 67,500 QALYs because of lower offer rates, 15,800 QALYs because of lower acceptance rates, and 2,600 QALYs because of higher complication rates.
African Americans lose 72,000 QALYs due to disparities in TKR offer and complication rates. Programs to decrease disparities in TKR use are urgently needed.
全膝关节置换术（TKR）是治疗膝关节骨关节炎（OA）终末期的有效方法。美国少数族裔接受 TKR 的人数少于白人。我们估计由于 TKR 的提供、接受和并发症发生率的差异，非裔美国人膝关节 OA 患者丧失的质量调整生命年（QALY）。
我们使用骨关节炎政策模型，这是一种膝关节 OA 的计算机模拟，来预测接受和不接受 TKR 的非裔美国人和白人膝关节 OA 患者的 QALY 结果。我们将 TKR 带来的人均 QALY 增益定义为当前 TKR 使用率下的 QALY 与未行 TKR 时的 QALY 之间的差异。我们将非裔美国人的人均 QALY 损失估计为白人 TKR 使用率下的 QALY 增益与非裔美国人 TKR 使用率下的 QALY 增益之间的差异。我们通过将人均 QALY 损失乘以患有晚期膝关节 OA 的人数来计算人群水平的 QALY 损失。最后，我们估计由于非裔美国膝关节 OA 患者 TKR 提供率和接受率较低以及并发症发生率较高而导致的 QALY 损失。
非裔美国男性和女性从当前 TKR 使用率中获得 64,100 个 QALY。如果采用白人的提供率和并发症率，他们将额外获得 72,000 个 QALY。由于这些额外的收益没有实现，我们称之为 72,000 个 QALY 的损失。由于提供率较低，非裔美国人损失 67,500 个 QALY；由于接受率较低，损失 15,800 个 QALY；由于并发症发生率较高，损失 2,600 个 QALY。
由于 TKR 的提供和并发症发生率的差异，非裔美国人丧失了 72,000 个 QALY。迫切需要制定减少 TKR 使用差异的计划。
