经皮骨整合假体治疗单侧股部截肢患者的成本效益分析。
Patients with unilateral transfemoral amputation treated with a percutaneous osseointegrated prosthesis: a cost-effectiveness analysis.
作者信息
Hansson E, Hagberg K, Cawson M, Brodtkorb T H
机构信息
Institute of Health and Care Sciences, Sahlgrenska Academy University of Gothenburg, Medicinaregatan 3, Gothenburg 413 90, Sweden and Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.
University of Gothenburg, Medicinaregatan 3, Gothenburg 413 90, Sweden and Advanced Reconstruction of Extremities and Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden.
出版信息
Bone Joint J. 2018 Apr 1;100-B(4):527-534. doi: 10.1302/0301-620X.100B4.BJJ-2017-0968.R1.
AIMS
The aim of this study was to compare the cost-effectiveness of treatment with an osseointegrated percutaneous (OI-) prosthesis and a socket-suspended (S-) prosthesis for patients with a transfemoral amputation.
PATIENTS AND METHODS
A Markov model was developed to estimate the medical costs and changes in quality-adjusted life-years (QALYs) attributable to treatment of unilateral transfemoral amputation over a projected period of 20 years from a healthcare perspective. Data were collected alongside a prospective clinical study of 51 patients followed for two years.
RESULTS
OI-prostheses had an incremental cost per QALY gained of €83 374 compared with S-prostheses. The clinical improvement seen with OI-prostheses was reflected in QALYs gained. Results were most sensitive to the utility value for both treatment arms. The impact of an annual decline in utility values of 1%, 2%, and 3%, for patients with S-prostheses resulted in a cost per QALY gained of €37 020, €24 662, and €18 952, respectively, over 20 years.
CONCLUSION
From a healthcare perspective, treatment with an OI-prosthesis results in improved quality of life at a relatively high cost compared with that for S-prosthesis. When patients treated with S-prostheses had a decline in quality of life over time, the cost per QALY gained by OI-prosthesis treatment was considerably reduced. Cite this article: Bone Joint J 2018;100-B:527-34.
目的
本研究旨在比较经皮骨整合（OI）假体和悬吊式（S）假体治疗经股骨截肢患者的成本效益。
患者与方法
建立马尔可夫模型，从医疗保健角度估计单侧经股骨截肢患者在预计20年期间接受治疗的医疗成本和质量调整生命年（QALY）的变化。数据收集自一项对51例患者进行为期两年的前瞻性临床研究。
结果
与S假体相比，OI假体每获得一个QALY的增量成本为83374欧元。OI假体所带来的临床改善体现在获得的QALY上。结果对两个治疗组的效用值最为敏感。对于使用S假体的患者，效用值每年下降1%、2%和3%，在20年期间每获得一个QALY的成本分别为37020欧元、24662欧元和18952欧元。
结论
从医疗保健角度来看，与S假体相比，OI假体治疗可提高生活质量，但成本相对较高。当使用S假体治疗的患者生活质量随时间下降时，OI假体治疗每获得一个QALY的成本会大幅降低。引用本文：《骨与关节杂志》2018年；100 - B：527 - 34。
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