1 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
2 Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
Clin Rehabil. 2019 Jun;33(6):1003-1014. doi: 10.1177/0269215519827628. Epub 2019 Feb 12.
To assess the costs, effects, and cost-utility of an accelerated physiotherapy programme versus a standard physiotherapy programme following resurfacing hip arthroplasty.
A cost-utility analysis alongside a randomized controlled trial.
A UK National Health Service hospital and patients' homes.
A total of 80 male resurfacing hip arthroplasty patients randomized post procedure to one of the two programmes.
The accelerated physiotherapy programme commenced in hospital with patients being fully weight bearing, without hip precautions, and following a range of exercises facilitating gait re-education, balance, and lower limb strength. Standard physiotherapy commenced in hospital, but hip precautions were used and exercises were only partially weight bearing. In both groups, patients continued with their exercises at home for an eight-week period.
Data on healthcare contacts were collected from patients to 12 months and costed using unit costs from national sources. Information was also collected on patients' costs. Health-related quality of life was measured using the EuroQol EQ-5D questionnaire and used to estimate quality-adjusted life years (QALYs) to 12 months. Mean costs and QALYs for each trial arm were compared.
On average, the accelerated physiotherapy programme was less expensive (mean cost difference -£200; 95% confidence interval: -£656 to £255) and more effective (mean QALY difference 0.13; 95% confidence interval: 0.05 to 0.21) than standard physiotherapy and had a high probability of being cost-effective.
From the National Health Service perspective, an accelerated physiotherapy programme for male patients undergoing revision of total hip arthroplasty (RHA) is very likely to be cost-effective when compared to a standard physiotherapy programme.
评估表面髋关节置换术后加速物理治疗方案与标准物理治疗方案的成本、效果和成本效益。
一项成本效益分析与随机对照试验相结合。
英国国民保健系统医院和患者家中。
80 名男性表面髋关节置换术患者随机分为两组，术后分别接受两种方案之一。
加速物理治疗方案在医院开始，患者完全负重，无需髋关节预防措施，并进行一系列练习，促进步态再教育、平衡和下肢力量。标准物理治疗在医院开始，但使用髋关节预防措施，仅部分负重进行练习。在两组中，患者在八周的时间内继续在家中进行锻炼。
从患者处收集 12 个月内的医疗保健接触数据，并使用国家来源的单位成本进行成本核算。还收集了患者的成本信息。使用 EuroQol EQ-5D 问卷测量健康相关生活质量，并用于估计 12 个月的质量调整生命年（QALY）。比较每个试验臂的平均成本和 QALY。
平均而言，加速物理治疗方案更便宜（平均成本差异-£200；95%置信区间：-£656 至 £255），更有效（平均 QALY 差异 0.13；95%置信区间：0.05 至 0.21），且具有很高的成本效益可能性。
从国家卫生服务的角度来看，与标准物理治疗方案相比，对接受全髋关节翻修术（RHA）的男性患者进行加速物理治疗方案非常可能具有成本效益。
