Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Gold Coast University Hospital, Queensland Health, Brisbane, Queensland, Australia; Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
J Arthroplasty. 2020 Jun;35(6):1614-1621. doi: 10.1016/j.arth.2020.02.001. Epub 2020 Feb 8.
Hip arthroplasty is increasing in Australia. The number of procedures for fractured neck of femur was 7500 in 2017. Best practices for fixation method and procedure type require scrutiny. This paper is about the costs and health outcomes of cemented and uncemented hemiarthroplasty and total hip arthroplasty at a national level.
We created a Markov model for patients <75, aged 75-85, and over 85. Expected costs and health outcomes over 5 years from a decision to change from existing practice to a best practice policy in which all patients with fractured neck of femur received the same fixation method based on age and type of arthroplasty are estimated. The model was populated using prevalence and incidence data from the Australian Orthopedic Association National Joint Replacement Registry, costs from Metro North Hospital and Health Service in Queensland, and probabilities and utilities from the literature. We simulated the uncertainties in outcomes with probabilistic sensitivity analysis.
We found that uncemented stem procedures were more costly and provided worse health outcomes compared to cemented stem fixation for hemiarthroplasty and total hip arthroplasty for all age groups. Moving from existing practice to cemented stem arthroplasty could save the Australian health system $2.0 million over 5 years with a gain of 203 quality-adjusted life years.
We suggest that consideration be given to cemented fixation of the femoral stem for patients receiving both hemiarthroplasty and total hip arthroplasty for fractured neck of femur. Best practice guidelines focused on cost-effectiveness should recommend cemented stem fixation to both save costs and improve patient quality of life.
髋关节置换术在澳大利亚不断增加。2017 年，股骨颈骨折的手术数量为 7500 例。固定方法和手术类型的最佳实践需要仔细审查。本文研究了全国范围内骨水泥固定和非骨水泥固定半髋关节置换术和全髋关节置换术的成本和健康结果。
我们为<75 岁、75-85 岁和>85 岁的患者创建了一个马尔可夫模型。根据年龄和关节置换类型，所有股骨颈骨折患者接受相同固定方法的最佳实践政策，估计从现有实践改变为最佳实践政策后 5 年内的预期成本和健康结果。该模型使用来自澳大利亚矫形协会全国关节置换登记处的患病率和发病率数据、昆士兰州梅特罗北医院和卫生服务处的成本以及文献中的概率和效用进行填充。我们使用概率敏感性分析模拟结果的不确定性。
我们发现，与骨水泥固定相比，非骨水泥固定在所有年龄段的半髋关节置换术和全髋关节置换术中都更昂贵，并且健康结果更差。从现有实践转向骨水泥固定可在 5 年内为澳大利亚卫生系统节省 200 万美元，并获得 203 个质量调整生命年。
我们建议考虑对接受股骨颈骨折半髋关节置换术和全髋关节置换术的患者进行股骨柄骨水泥固定。以成本效益为重点的最佳实践指南应建议使用骨水泥固定，以节省成本和提高患者的生活质量。
