Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2020 Jul;35(7):1766-1775.e3. doi: 10.1016/j.arth.2020.02.044. Epub 2020 Mar 13.
The cost-effectiveness of bariatric surgery to achieve weight loss prior to total hip arthroplasty (THA), and decrease the complications and costs associated with THA in the morbidly obese, is unknown. This study evaluated the cost-effectiveness of bariatric surgery prior to THA for morbidly obese patients with end-stage hip osteoarthritis (OA).
A state-transition Markov model was constructed to compare the cost-utility of 2 treatment protocols for patients with morbid obesity and end-stage hip OA: (1) immediate THA and (2) bariatric surgery 2 years prior to THA (combined protocol). The analysis was performed from both a payer and a societal perspective using direct and indirect costs over a 40-year time horizon. Utilities, associated costs, and probabilities for health state transitions were derived from the literature. One-way, 2-way and probabilistic sensitivity analyses were performed to validate the robustness of the base case results, using the standard willingness-to-pay threshold of $100,000/quality-adjusted life years.
From the societal perspective, the combined protocol was more effective (13.16 vs 12.26) with less cost ($91,717 vs $92,684) and thus was the dominant strategy over immediate THA. These results were stable across broad ranges for independent model variables. Monte Carlo simulation with 100,000 samples demonstrated that bariatric surgery prior to THA was the preferred cost-effective strategy over 95% of the time from both a societal and payer perspective.
In the morbidly obese patient with end-stage hip OA, bariatric surgery prior to THA is a cost-effective strategy for improving quality of life and decreasing societal and payer costs.
II.
在病态肥胖患者中，减重手术是否比全髋关节置换术（THA）更具成本效益，以及是否能降低与 THA 相关的并发症和成本，目前尚不清楚。本研究评估了在终末期髋关节骨关节炎（OA）的病态肥胖患者中，在进行 THA 之前进行减重手术的成本效益。
构建状态转移马尔可夫模型，以比较两种治疗方案对病态肥胖且终末期髋关节 OA 患者的成本效益：（1）直接进行 THA 和（2）在 THA 前 2 年进行减重手术（联合方案）。从支付者和社会角度，通过直接和间接成本，在 40 年的时间范围内进行分析。使用文献中的健康状态转换概率、效用和相关成本来计算。使用 100,000 美元/质量调整生命年的标准意愿支付阈值，进行了单因素、双因素和概率敏感性分析，以验证基本情况结果的稳健性。
从社会角度来看，联合方案更有效（13.16 比 12.26），成本更低（91,717 美元比 92,684 美元），因此是直接进行 THA 的主导策略。这些结果在广泛的模型变量范围内是稳定的。通过 100,000 个样本的蒙特卡罗模拟表明，在 95%的时间内，从社会和支付者的角度来看，THA 之前的减重手术是一种具有成本效益的策略。
在终末期髋关节 OA 的病态肥胖患者中，THA 之前进行减重手术是一种提高生活质量和降低社会和支付者成本的成本效益策略。
II。
