膝关节骨关节炎患者 12 周监督治疗与书面建议的成本效益比较：一项随机试验 2 年结局的二次分析。

Cost-effectiveness of 12 weeks of supervised treatment compared to written advice in patients with knee osteoarthritis: a secondary analysis of the 2-year outcome from a randomized trial.

机构信息

Orthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, 9000, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, 4200, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, 9220, Denmark.

Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark.

出版信息

Osteoarthritis Cartilage. 2020 Jul;28(7):907-916. doi: 10.1016/j.joca.2020.03.009. Epub 2020 Mar 31.

DOI:10.1016/j.joca.2020.03.009

PMID:32243994

Abstract

OBJECTIVE

To assess the 24-month cost-effectiveness of supervised treatment compared to written advice in knee osteoarthritis (OA).

DESIGN

100 adults with moderate-severe OA not eligible for total knee replacement (TKR) randomized to a 12-week individualized, supervised treatment (exercise, education, diet, insoles and pain medication) or written advice. Effectiveness was measured as change in quality-adjusted life years (QALYs) from baseline to 24 months, including data from baseline, 3, 6, 12 and 24 months, while healthcare costs and transfer payments were derived from national registries after final follow-up. Incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. A sensitivity analysis resampling existing data was conducted and the probability of cost-effectiveness was estimated using a 22,665 Euros/QALY threshold. In a sensitivity analysis, cost-effectiveness was calculated for different costs of the supervised treatment (actual cost in study; cost in private practice; and in-between cost).

RESULTS

Average costs were similar between groups (6,758 Euros vs 6,880 Euros), while the supervised treatment were close to being more effective (incremental effect (95% CI) of 0.075 (-0.005 to 0.156). In the primary analysis excluding deaths, this led the supervised treatment to be cost-effective, compared to written advice. The sensitivity analysis demonstrated that the results were sensitive to changes in the cost of treatment, but in all scenarios the supervised treatment was cost-effective (ICERs of 6,229 to 20,688 Euros/QALY).

CONCLUSIONS

From a 24-month perspective, a 12-week individualized, supervised treatment program is cost-effective compared to written advice in patients with moderate-severe knee OA not eligible for TKR.

TRIAL REGISTRATION

ClinicalTrials.gov number: NCT01535001.

摘要

目的

评估在膝关节骨关节炎（OA）中，监督治疗与书面建议相比 24 个月的成本效益。

设计

100 名不符合全膝关节置换术（TKR）条件的中重度 OA 成年人随机分为 12 周的个体化监督治疗（运动、教育、饮食、鞋垫和止痛药）或书面建议组。有效性测量为从基线到 24 个月的质量调整生命年（QALYs）变化，包括基线、3、6、12 和 24 个月的数据，而医疗保健成本和转移支付则来自最终随访后的国家登记处。计算增量成本、质量调整生命年（QALYs）和增量成本效益比（ICERs）。进行了基于现有数据的敏感性分析，并使用 22665 欧元/QALY 的阈值估计成本效益的概率。在敏感性分析中，计算了监督治疗不同成本（研究中的实际成本、私人执业中的成本和介于两者之间的成本）的成本效益。

结果

两组的平均成本相似（6758 欧元与 6880 欧元），而监督治疗的效果接近更好（增量效应（95%CI）为 0.075（-0.005 至 0.156）。在排除死亡的主要分析中，与书面建议相比，监督治疗具有成本效益。敏感性分析表明，结果对治疗成本的变化敏感，但在所有情况下，监督治疗都是具有成本效益的（ICER 为 6229 至 20688 欧元/QALY）。