Burn Edward, Liddle Alexander D, Hamilton Thomas W, Judge Andrew, Pandit Hemant G, Murray David W, Pinedo-Villanueva Rafael
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, University College London, Stanmore, UK.
BMJ Open. 2018 Apr 29;8(4):e020977. doi: 10.1136/bmjopen-2017-020977.
To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR).
A lifetime Markov model provided the framework for the analysis.
Data from the National Joint Registry (NJR) for England and Wales primarily informed the analysis.
Propensity score matched patients in the NJR who received either a UKR or TKR.
UKR is a less invasive alternative to TKR, where only the compartment affected by osteoarthritis is replaced.
Incremental quality-adjusted life years (QALYs) and healthcare system costs.
The provision of UKR is expected to lead to a gain in QALYs compared with TKR for all age and gender subgroups (male: <60 years: 0.12, 60-75 years: 0.20, 75+ years: 0.19; female: <60 years: 0.10, 60-75 years: 0.28, 75+ years: 0.44) and a reduction in costs (male: <60: £-1223, 60-75 years: £-1355, 75+ years: £-2005; female: <60 years: £-601, 60-75 years: £-935, 75+ years: £-1102 per patient over the lifetime). UKR is expected to lead to a reduction in QALYs compared with TKR when performed by surgeons with low UKR utilisation but an increase among those with high utilisation (<10%, median 6%: -0.04, ≥10%, median 27%: 0.26). Regardless of surgeon usage, costs associated with UKR are expected to be lower than those of TKR (<10%: £-127, ≥10%: £-758).
UKR can be expected to generate better health outcomes and lower lifetime costs than TKR. Surgeon usage of UKR does, however, have a significant impact on the cost-effectiveness of the procedure. To achieve the best results, surgeons need to perform a sufficient proportion of knee replacements as UKR. Low usage surgeons may therefore need to broaden their indications for UKR.
评估单髁膝关节置换术（UKR）与全膝关节置换术（TKR）相比的性价比。
采用终身马尔可夫模型为分析提供框架。
主要依据英格兰和威尔士国家关节注册中心（NJR）的数据进行分析。
NJR中接受UKR或TKR的倾向评分匹配患者。
UKR是TKR的一种侵入性较小的替代方案，仅替换受骨关节炎影响的关节间室。
增量质量调整生命年（QALYs）和医疗系统成本。
与TKR相比，UKR预计在所有年龄和性别亚组中均能带来QALYs的增加（男性：<60岁：0.12，60 - 75岁：0.20，75岁以上：0.19；女性：<60岁：0.10，60 - 75岁：0.28，75岁以上：0.44），并降低成本（男性：<60岁：-1223英镑，60 - 75岁：-1355英镑，75岁以上：-2005英镑；女性：<60岁：-601英镑，60 - 75岁：-935英镑，75岁以上：每位患者终身-1102英镑）。当由UKR使用率低的外科医生进行UKR时，预计与TKR相比QALYs会减少，但在高使用率（<10%，中位数6%：-0.04，≥10%，中位数27%：0.26）的医生中会增加。无论外科医生的使用情况如何，UKR相关成本预计低于TKR（<10%：-127英镑，≥10%：-758英镑）。
与TKR相比，UKR有望产生更好的健康结局和更低的终身成本。然而，外科医生对UKR的使用确实会对该手术的成本效益产生重大影响。为了取得最佳效果，外科医生需要进行足够比例的UKR膝关节置换术。因此，低使用率的外科医生可能需要扩大UKR的适应症。
