Loveday David T, Barr Lynne V, Loizou Constantinos L, Barton Garry, Smith George
Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
Foot Ankle Surg. 2018 Feb;24(1):54-59. doi: 10.1016/j.fas.2016.11.008. Epub 2016 Nov 25.
This study assessed the health economics and outcomes of three common foot and ankle operations.
Between July 2013 and October 2014 all patients undergoing ankle fusion (AF) for osteoarthritis, first metatarsophalangeal joint fusion for osteoarthritis (MF) or hallux valgus surgery (HV) were included. Patients having additional procedures were excluded. Patients completed the Manchester-Oxford Foot Questionnaire (MOX-FQ), the EuroQol EQ-5D-5L questionnaire and the EQ-VAS on presentation and at least 6 months post-operatively.
63 patients undergoing AF (n=22), MF (n=22), or HV (n=32) completed preoperative and postoperative questionnaires. 76 completed preoperative questionnaires and 63 completed the follow up questionnaires. The follow up questionnaires were completed at a median of 12 months (range 6-24 months) following surgery. The mean age at surgery was 59 years (range 26-85 years). Pre-operative MOX-FQ and EQ-5D-5L scores differed significantly between the three groups with AF and MF patients reporting worse scores compared to HV patients. MOX-FQ and EQ-5D-5L significantly improved in all groups from pre-operative levels.
MOX-FQ: AF from 53.8 (CI 56.8-50.8) to 22.9 (CI 30.9-14.9), MF from 43.0 (CI 46.4-39.6) to 12.1 (CI 18.3-5.9), HV from 35.4 (CI 39.0-31.7) to 15.6 (CI 21.1-10.1). EQ-5D-5L: AF from 0.30 (CI 0.43-0.17) to 0.66 (CI 0.77-0.55), MF from 0.45(CI 0.52-0.38) to 0.83 (CI 0.90-0.76), HV from 0.71(CI 0.74-0.68) to 0.82 (CI 0.88-0.76). There was no significant difference in the EQ-VAS suggesting it may not be representative of foot and ankle health. Health economics analysis using the EQ-5D-5L data to estimate quality-adjusted life years (QALYs) suggested all three procedures were favourable compared to threshold levels of cost-effectiveness. There were differences in estimated costs between the three operations with AF at £2950 (threshold cost <£5400) and MF at £1197 (threshold cost <£5780) and HV varying from £625 to £1688 (threshold cost <£1640).
This study reveals that the joint-specific (MOX-FQ) and generic health (EQ-5D-5L) outcome scores of patients improved after AF, MF and HV. The greatest benefit from surgery was gained in the arthritic patient groups. In the future, the use of large population patient reported outcome measures data may also potentially have implications for prioritisation of healthcare provision, acting as an indicator of foot and ankle surgical procedures that produce the most benefit to patients.
本研究评估了三种常见足踝手术的健康经济学情况及手术效果。
纳入2013年7月至2014年10月期间所有因骨关节炎接受踝关节融合术（AF）、因骨关节炎接受第一跖趾关节融合术（MF）或拇外翻手术（HV）的患者。排除接受额外手术的患者。患者在就诊时及术后至少6个月完成曼彻斯特 - 牛津足部问卷（MOX - FQ）、欧洲五维度健康量表（EQ - 5D - 5L）问卷及视觉模拟量表（EQ - VAS）。
63例接受AF（n = 22）、MF（n = 22）或HV（n = 32）手术的患者完成了术前和术后问卷。76例患者完成了术前问卷，63例患者完成了随访问卷。随访问卷在术后中位时间12个月（范围6 - 24个月）完成。手术时的平均年龄为59岁（范围26 - 85岁）。三组患者术前MOX - FQ和EQ - 5D - 5L评分差异显著，与HV组患者相比，AF组和MF组患者报告的评分更差。所有组的MOX - FQ和EQ - 5D - 5L评分均较术前水平有显著改善。
MOX - FQ：AF组从53.8（可信区间56.8 - 50.8）降至22.9（可信区间30.9 - 14.9），MF组从43.0（可信区间46.4 - 39.6）降至12.1（可信区间18.3 - 5.9），HV组从35.4（可信区间39.0 - 31.7）降至15.6（可信区间21.1 - 10.1）。EQ - 5D - 5L：AF组从0.30（可信区间0.43 - 0.17）升至0.66（可信区间0.77 - 0.55），MF组从0.45（可信区间0.52 - 0.38）升至0.83（可信区间0.90 - 0.76），HV组从0.71（可信区间0.74 - 0.68）升至0.82（可信区间0.88 - 0.76）。EQ - VAS无显著差异，提示其可能不代表足踝健康状况。使用EQ - 5D - 5L数据进行健康经济学分析以估计质量调整生命年（QALY），结果表明与成本效益阈值水平相比，所有三种手术都是有利的。三种手术的估计成本存在差异，AF手术为2950英镑（成本效益阈值 < 5400英镑），MF手术为1197英镑（成本效益阈值 < 5780英镑），HV手术从625英镑至1688英镑不等（成本效益阈值 < 1640英镑）。
本研究表明，AF、MF和HV手术后患者的关节特异性（MOX - FQ）和总体健康（EQ - 5D - 5L）结局评分有所改善。关节炎患者组从手术中获益最大。未来，使用大量患者报告结局测量数据可能也会对医疗保健服务的优先排序产生潜在影响，作为对患者最有益的足踝外科手术的指标。
