1 Department of Radiology, NYU Langone Medical Center, 660 First Ave, New York, NY 10016.
2 Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Orthopedic Hospital, New York, NY.
AJR Am J Roentgenol. 2018 Jun;210(6):1279-1287. doi: 10.2214/AJR.17.19011. Epub 2018 Apr 9.
The purpose of this study was to determine the cost-effectiveness of landmark-based and image-guided intraarticular steroid injections for the initial treatment of a population with adhesive capsulitis.
A decision analytic model from the health care system perspective over a 6-month time frame for 50-year-old patients with clinical findings consistent with adhesive capsulitis was used to evaluate the incremental cost-effectiveness of three techniques for administering intraarticular steroid to the glenohumeral joint: landmark based (also called blind), ultrasound guided, and fluoroscopy guided. Input data on cost, probability, and utility estimates were obtained through a comprehensive literature search and from expert opinion. The primary effectiveness outcome was quality-adjusted life years (QALY). Costs were estimated in 2017 U.S. dollars.
Ultrasound-guided injections were the dominant strategy for the base case, because it was the least expensive ($1280) and most effective (0.4096 QALY) strategy of the three options overall. The model was sensitive to the probabilities of getting the steroid into the joint by means of blind, ultrasound-guided, and fluoroscopy-guided techniques and to the costs of the ultrasound-guided and blind techniques. Two-way sensitivity analyses showed that ultrasound-guided injections were favored over blind and fluoroscopy-guided injections over a range of reasonable probabilities and costs. Probabilistic sensitivity analysis showed that ultrasound-guided injections were cost-effective in 44% of simulations, compared with 34% for blind injections and 22% for fluoroscopy-guided injections and over a wide range of willingness-to-pay thresholds.
Ultrasound-guided injections are the most cost-effective option for the initial steroid-based treatment of patients with adhesive capsulitis. Blind and fluoroscopy-guided injections can also be cost-effective when performed by a clinician likely to accurately administer the medication into the correct location.
本研究旨在确定基于标志和图像引导的关节内皮质类固醇注射在粘连性肩关节囊炎初始治疗人群中的成本效益。
使用 50 岁患者的临床发现符合粘连性肩关节囊炎的关节内皮质类固醇给药的三种技术（基于标志[也称为盲法]、超声引导和透视引导）的决策分析模型，从医疗保健系统的角度评估 6 个月时间框架内的增量成本效益。通过全面的文献检索和专家意见获得成本、概率和效用估计的输入数据。主要有效性结果是质量调整生命年（QALY）。成本以 2017 年美元计算。
在基础情况下，超声引导注射是最具成本效益的策略，因为它是三种选择中最便宜（1280 美元）和最有效的（0.4096 QALY）策略。该模型对通过盲法、超声引导和透视引导技术将皮质类固醇注入关节的概率以及超声引导和盲法技术的成本敏感。双向敏感性分析表明，在合理的概率和成本范围内，超声引导注射优于盲法和透视引导注射。概率敏感性分析表明，在广泛的支付意愿阈值范围内，与盲法注射相比，超声引导注射在 44%的模拟中具有成本效益，而透视引导注射为 34%。
对于粘连性肩关节囊炎患者的初始皮质类固醇治疗，超声引导注射是最具成本效益的选择。当由可能准确将药物注射到正确位置的临床医生进行时，盲法和透视引导注射也可能具有成本效益。
