Eibich Peter, Dakin Helen A, Price Andrew James, Beard David, Arden Nigel K, Gray Alastair M
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Max Planck Institute for Demographic Research, Rostock, Germany.
BMJ Open. 2018 Apr 10;8(4):e019477. doi: 10.1136/bmjopen-2017-019477.
To assess how costs and quality of life (measured by EuroQoL-5 Dimensions (EQ-5D)) before and after total hip replacement (THR) and total knee replacement (TKR) vary with age, gender and preoperative Oxford hip score (OHS) and Oxford knee score (OKS).
Regression analyses using prospectively collected data from clinical trials, cohort studies and administrative data bases.
UK secondary care.
Men and women undergoing primary THR or TKR. The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years. The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years. The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year.
EQ-5D-3L quality of life before and after surgery, costs of primary arthroplasty, costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement.
Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile. The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10. However, postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44. In contrast, costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS. For example, costs of hospital readmissions within 12 months after primary THR/TKR were £740/£888 for patients at the 5th percentile compared with £314/£404 at the 95th percentile of the OHS/OKS distribution.
Our findings suggest that costs and quality of life associated with total joint replacement vary systematically with preoperative symptoms measured by OHS/OKS.
评估全髋关节置换术（THR）和全膝关节置换术（TKR）前后的成本和生活质量（采用欧洲五维健康量表（EQ-5D）进行测量）如何随年龄、性别以及术前牛津髋关节评分（OHS）和牛津膝关节评分（OKS）而变化。
使用来自临床试验、队列研究和行政数据库的前瞻性收集数据进行回归分析。
英国二级医疗保健机构。
接受初次THR或TKR的男性和女性。与患者报告的结局指标相关联的医院病历统计数据包括602176例接受髋关节或膝关节置换术的患者，随访时间长达6年。膝关节置换术试验包括2217例接受TKR的患者，随访时间为12年。关节置换术临床结局研究队列包括806例接受THR的患者和484例接受TKR的患者，观察时间为1年。
手术前后的EQ-5D-3L生活质量、初次关节置换术的成本、翻修关节置换术的成本以及关节置换术前一年至术后12年内的住院再入院成本和门诊成本。
在OHS/OKS分布的第5百分位数的患者中，THR/TKR术后平均效用值为0.61/0.5，而在第95百分位数的患者中为0.89/0.85。术前OHS/OKS低于10的患者术后与术前EQ-5D效用值的差异最大。然而，对于所有OHS≤46的患者和OKS≤44的患者，术后EQ-5D效用值均高于术前效用值。相比之下，术前OHS/OKS较低的患者的成本通常高于OHS/OKS较高的患者。例如，初次THR/TKR术后12个月内的住院再入院成本，在OHS/OKS分布的第5百分位数的患者中为740英镑/888英镑，而在第95百分位数的患者中为314英镑/404英镑。
我们的研究结果表明，全关节置换术相关的成本和生活质量随OHS/OKS所测量的术前症状而系统变化。
