患者决策辅助工具对关节置换和医疗保健费用的长期影响。

Long-term effect of patient decision aids on use of joint replacement and health care costs.

机构信息

University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada.

University of Ottawa, Ottawa, Canada.

出版信息

Osteoarthritis Cartilage. 2020 Jun;28(6):819-823. doi: 10.1016/j.joca.2020.01.019. Epub 2020 Mar 12.

DOI:10.1016/j.joca.2020.01.019

PMID:32173628

Abstract

OBJECTIVE

Shared decision-making supported by patient decisions aids may improve care and reduce healthcare costs for persons considering total joint replacement. Observational studies and randomized controlled trials (RCTs) have evaluated the short-term impact of decision aids on uptake of surgery and costs, however the long-term effects are unclear. This analysis aimed to evaluate the effect of patient decision aids on 1) use of joint replacement up to 7-years of follow-up, and 2) osteoarthritis-related health system costs.

METHODS

324 participants in a Canadian RCT with 2-years follow-up who were randomized to either a decision aid (n = 161) or usual care (n = 163) had their trial and health administrative data linked. The proportion undergoing surgery up to 7-years were compared using cumulative incidence plots and competing risk regression. Mean per-patient costs were compared using two sample t-tests.

RESULTS

At 2-years, 119 of 161 (73.9%) patients in the decision aid arm and 129 of 163 (79.1%) patients in the usual care arm had surgery. Between two and 7-years, 17 additional patients in both the decision aid (of 42, 40.4%) and usual care (of 34, 50.0%) arms underwent surgery. At 7-years, patients exposed to decision aids had a similar likelihood of undergoing surgery (HR = 0.92, 95% CI:0.73 to 1.17, p = 0.49) and mean per-patient costs ($21,965 vs $23,681, incremental cost: -$1,717, 95% CI:-$5,631 to $2,198) compared to those in usual care.

CONCLUSIONS

This is the first study to assess the long-term impact of decision aids on use of joint replacement and healthcare costs. These results are not conclusive but can inform future trial design.

CLINICAL TRIAL REGISTRATION

The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).

摘要

目的

在考虑接受全关节置换的患者中，基于患者决策辅助的共同决策可能会改善护理并降低医疗保健成本。观察性研究和随机对照试验（RCT）已经评估了决策辅助对手术采用率和成本的短期影响，但长期效果尚不清楚。本分析旨在评估患者决策辅助对以下两个方面的影响：1）7 年随访期间的关节置换使用情况；2）骨关节炎相关的卫生系统成本。

方法

对参加加拿大 RCT 的 324 名参与者（2 年随访期）进行了分析，这些参与者被随机分配至决策辅助组（n=161）或常规护理组（n=163），并对他们的试验和健康管理数据进行了链接。使用累积发病率图和竞争风险回归比较了 7 年内接受手术的比例。使用两样本 t 检验比较每位患者的平均成本。

结果

在 2 年时，决策辅助组 161 名患者中有 119 名（73.9%）和常规护理组 163 名患者中有 129 名（79.1%）接受了手术。在 2 年至 7 年期间，决策辅助组（42 名中的 17 名，40.4%）和常规护理组（34 名中的 17 名，50.0%）中各有 17 名患者接受了手术。在 7 年时，接受决策辅助的患者接受手术的可能性相似（HR=0.92，95%CI：0.73 至 1.17，p=0.49），每位患者的平均成本（21,965 美元与 23,681 美元，增量成本：-$1,717，95%CI：-$5,631 至 $2,198）与常规护理组相比无显著差异。