Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Am J Sports Med. 2018 Apr;46(5):1205-1213. doi: 10.1177/0363546518757758. Epub 2018 Mar 13.
The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy.
This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery.
Economic and decision analysis; Level of evidence, 2.
The cost-effectiveness of hip arthroscopy versus nonoperative treatment was evaluated by calculating direct and indirect treatment costs. Direct cost was calculated with Current Procedural Terminology medical codes associated with FAI treatment. Indirect cost was measured with the patient-reported data of 102 patients who underwent arthroscopy and from the reimbursement records of 32,143 individuals between the ages of 16 and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. The indirect economic benefits of hip arthroscopy were inferred through regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. To analyze cost-effectiveness, 1-, 2-, and 3-way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis evaluated the impact of uncertainty in the model assumptions.
Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity of $8968 after surgery. Cost-effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy versus nonoperative treatment. Hip arthroscopy also conferred a gain of 2.03 quality-adjusted life years over this period. The mean cost for hip arthroscopy was estimated at $23,120 ± $10,279, and the mean cost of nonoperative treatment was estimated at $91,602 ± $14,675. In 99% of trials, hip arthroscopy was recognized as the preferred cost-effective strategy.
FAI syndrome produces a substantial economic burden on society that may be reduced through the indirect cost savings and economic benefits from hip arthroscopy.
在过去十年中，股骨髋臼撞击症（FAI）的诊断和治疗稳步增加，研究表明髋关节镜治疗 FAI 后临床有显著改善。
本研究通过对低龄（<50 岁）、非争议性诊断和手术适应证的 FAI 综合征患者的高容量髋关节镜手术，探讨髋关节镜的社会和经济影响。
经济和决策分析；证据水平，2 级。
通过计算直接和间接治疗成本，评估髋关节镜与非手术治疗的成本效益。直接成本通过与 FAI 治疗相关的当前操作术语（Current Procedural Terminology，CPT）医疗代码计算得出。间接成本通过对接受关节镜手术的 102 例患者的患者报告数据和 PearlDiver 患者记录数据库中私人保险理赔记录中 16 至 79 岁 32143 例个体的报销记录进行测量。通过回归分析推断髋关节镜的间接经济效益，以估计功能状态和生产力之间的统计关系。然后使用基于模拟的方法估计治疗队列中基线和随访时功能状态变化与观察到的生产力变化之间的相关性。为了进行成本效益分析，对模型中的所有变量进行了 1 、 2 、 3 种方式的敏感性分析，蒙特卡罗分析评估了模型假设不确定性的影响。
间接成本分析确定手术后平均总生产力增加了 8968 美元。成本效益分析显示，与非手术治疗相比，髋关节镜治疗每位患者 10 年的总社会节省 67418 美元。髋关节镜治疗还在此期间获得了 2.03 个质量调整生命年的增益。髋关节镜的平均成本估计为 23120 美元±10279 美元，非手术治疗的平均成本估计为 91602 美元±14675 美元。在 99%的试验中，髋关节镜被认为是更具成本效益的策略。
FAI 综合征给社会带来了巨大的经济负担，通过髋关节镜治疗的间接成本节约和经济效益，这种负担可能会减轻。
