增强型康复在髋关节和膝关节置换中的成本效益：系统评价方案。
Cost-effectiveness of enhanced recovery in hip and knee replacement: a systematic review protocol.
机构信息
Health Economics Research Centre, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.
Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
出版信息
BMJ Open. 2018 Mar 14;8(3):e019740. doi: 10.1136/bmjopen-2017-019740.
INTRODUCTION
Hip and knee replacement represents a significant burden to the UK healthcare system. 'Enhanced recovery' pathways have been introduced in the National Health Service (NHS) for patients undergoing hip and knee replacement, with the aim of improving outcomes and timely recovery after surgery. To support policymaking, there is a need to evaluate the cost-effectiveness of enhanced recovery pathways across jurisdictions. Our aim is to systematically summarise the published cost-effectiveness evidence on enhanced recovery in hip and knee replacement, both as a whole and for each of the various components of enhanced recovery pathways.
METHODS AND ANALYSIS
A systematic review will be conducted using MEDLINE, EMBASE, Econlit and the National Health Service Economic Evaluations Database. Separate search strategies were developed for each database including terms relating to hip and knee replacement/arthroplasty, economic evaluations, decision modelling and quality of life measures.We will extract peer-reviewed studies published between 2000 and 2017 reporting economic evaluations of preoperative, perioperative or postoperative enhanced recovery interventions within hip or knee replacement. Economic evaluations alongside cohort studies or based on decision models will be included. Only studies with patients undergoing elective replacement surgery of the hip or knee will be included. Data will be extracted using a predefined pro forma following best practice guidelines for economic evaluation, decision modelling and model validation.Our primary outcome will be the cost-effectiveness of enhanced recovery (entire pathway and individual components) in terms of incremental cost per quality-adjusted life year. A narrative synthesis of all studies will be presented, focussing on cost-effectiveness results, study design, quality and validation status.
ETHICS AND DISSEMINATION
This systematic review is exempted from ethics approval because the work is carried out on published documents. The results of the review will be disseminated in a peer-reviewed academic journal and at conferences.
PROSPERO REGISTRATION NUMBER
CRD42017059473.
简介
髋关节和膝关节置换术给英国医疗保健系统带来了巨大的负担。英国国民健康服务体系（NHS）为髋关节和膝关节置换术患者引入了“强化康复”路径，旨在改善手术治疗后的结果和康复速度。为了支持决策制定，需要在不同司法管辖区评估强化康复路径的成本效益。我们的目的是系统地总结髋关节和膝关节置换术强化康复的已发表成本效益证据，包括整个强化康复路径以及强化康复路径各个组成部分的成本效益证据。
方法和分析
将使用 MEDLINE、EMBASE、Econlit 和英国国家卫生服务经济评估数据库进行系统综述。为每个数据库制定了单独的搜索策略，包括与髋关节和膝关节置换/关节成形术、经济评估、决策模型和生活质量措施相关的术语。我们将提取 2000 年至 2017 年期间发表的同行评议研究，报告髋关节或膝关节置换术的术前、围手术期或术后强化康复干预的经济评估。将包括经济评估与队列研究或基于决策模型的研究。仅纳入接受髋关节或膝关节择期置换手术的患者的研究。将按照经济评估、决策模型和模型验证的最佳实践指南，使用预定义的方案提取数据。我们的主要结果将是强化康复（整个路径和各个组成部分）在增量成本每质量调整生命年方面的成本效益。将根据成本效益结果、研究设计、质量和验证状态对所有研究进行叙述性综合。
伦理和传播
由于这项系统综述是基于已发表的文献进行的，因此无需伦理批准。综述的结果将在同行评议的学术期刊和会议上发表。
PROSPERO 注册号：CRD42017059473。
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