1 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
2 Department of Surgery, University of Calgary, Calgary, AB, Canada.
Foot Ankle Int. 2019 Mar;40(3):336-342. doi: 10.1177/1071100718815663. Epub 2018 Dec 17.
: Bunion correction surgery is a very common procedure to improve patients' pain and physical function attributable to a misaligned first metatarsophalangeal joint. The objective of this study was to apply a health utility framework to estimate the cost utility of bunion correction surgery.
: Patients were prospectively recruited from the population of patients seen in a lower-extremity orthopedic clinic and scheduled for isolated bunion surgery. Participants completed EuroQoL's EQ-5D(3L) to measure patients' current general health preoperatively and 6 months postoperatively. Participants' change in quality-adjusted life years (QALYs) were calculated by comparing the difference between postoperative utility values and preoperative utility values. The study had 95 patients representing 53% of eligible patients.
: The mean preoperative utility value was 0.6816 and the mean postoperative value was 0.7451, a statistically significant difference denoting an improvement in self-reported health. The cost per QALY, assuming gains in health accrued for 15 years, was $4911 (the 95% confidence interval ranged from $4736 to $5088). The cost per QALY was highest among the oldest patients. Assuming gains in health accrued for 20 years, the cost per QALY was $3922.
: This study demonstrated that bunion correction surgery was inexpensive relative to its gains in health compared with commonly applied thresholds for women and men in all age groups, though the gains were not uniformly distributed across age categories. Future research should examine the impact of recurrence on the robustness of these findings.
: Level III, comparative study.
拇囊炎矫正手术是一种非常常见的手术，可以改善因第一跖趾关节错位而导致的患者疼痛和身体功能。本研究的目的是应用健康效用框架来评估拇囊炎矫正手术的成本效用。
从下肢矫形诊所就诊并计划接受单纯拇囊炎手术的患者中前瞻性招募患者。参与者使用 EuroQoL 的 EQ-5D(3L) 在术前和术后 6 个月评估患者当前的总体健康状况。通过比较术后效用值与术前效用值之间的差异来计算参与者的质量调整生命年（QALY）变化。该研究共有 95 名患者，占符合条件患者的 53%。
术前平均效用值为 0.6816，术后平均效用值为 0.7451，统计学差异表明自我报告的健康状况有所改善。假设健康收益持续 15 年，每 QALY 的成本为 4911 美元（95%置信区间为 4736 美元至 5088 美元）。最年长的患者每 QALY 的成本最高。假设健康收益持续 20 年，每 QALY 的成本为 3922 美元。
与女性和男性在所有年龄组中普遍应用的阈值相比，该研究表明拇囊炎矫正手术的成本相对较低，与其健康收益相比，尽管这些收益在不同年龄段之间的分布并不均匀。未来的研究应检查复发对这些发现的稳健性的影响。
三级，比较研究。
