van der Linde Just A, Bosmans Judith E, Ter Meulen Dirk P, van Kampen Derk A, van Deurzen Derek Fp, Haverlag Robert, Saris Daniel Bf, van den Bekerom Michel Pj
Department of Orthopedic Surgery and Traumatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands.
Shoulder Elbow. 2019 Aug;11(4):265-274. doi: 10.1177/1758573218773543. Epub 2018 May 14.
Shoulder instability is associated with decreased functioning. The associated costs could be substantial and interesting to clinicians, researchers, and policy makers. This prospective observational study aims to (1) estimate productivity losses and healthcare expenses following the nonoperative treatment of shoulder instability and (2) identify patient characteristics that influence societal costs.
One hundred and thirty-two patients completed a questionnaire regarding production losses and healthcare utilization following consecutive episodes of shoulder instability. Productivity losses were calculated using the friction cost approach. Healthcare utilization was evaluated using standard costs. analysis of variance test was used to assess which patient characteristics are related to productivity losses and healthcare expenses. Societal costs were assessed using multilevel analyses. Bootstrapping was used to estimate statistical uncertainty.
Mean productivity losses are €1469, €881, and €728 and mean healthcare expenses are €3759, €3267, and €2424 per patient per dislocation for the first, second, and third dislocation. Productivity losses decrease significantly after the second (mean difference €-1969, 95%CI= -3680 to -939) and third (mean difference €-2298, 95%CI= -4092 to -1288) compared to the first dislocation.
Nonoperative treatment of shoulder instability has substantial societal costs.
III, economic analysis.
肩关节不稳定与功能下降相关。相关成本可能很高，对临床医生、研究人员和政策制定者来说很有意义。这项前瞻性观察性研究旨在：（1）估计肩关节不稳定非手术治疗后的生产力损失和医疗费用；（2）确定影响社会成本的患者特征。
132名患者完成了一份关于肩关节不稳定连续发作后的生产损失和医疗利用情况的问卷。生产力损失采用摩擦成本法计算。医疗利用情况采用标准成本进行评估。使用方差分析测试来评估哪些患者特征与生产力损失和医疗费用相关。社会成本采用多水平分析进行评估。使用自抽样法估计统计不确定性。
首次、第二次和第三次脱位时，每位患者每次脱位的平均生产力损失分别为1469欧元、881欧元和728欧元，平均医疗费用分别为3759欧元、3267欧元和2424欧元。与首次脱位相比，第二次（平均差异为-1969欧元，95%置信区间=-3680至-939）和第三次（平均差异为-2298欧元，95%置信区间=-4092至-1288）脱位后的生产力损失显著降低。
肩关节不稳定的非手术治疗具有巨大的社会成本。
III，经济分析。
