American Hip Institute Research Foundation, Des Plaines, IL, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Hip Int. 2021 Sep;31(5):572-581. doi: 10.1177/1120700020952776. Epub 2020 Aug 27.
The purpose of this study was to perform a cost-effectiveness analysis of outpatient versus inpatient total hip arthroplasty (THA) in the USA, considering complication probability and the potential cost of such complications.
A cost-effectiveness analysis was conducted from the societal perspective to evaluate the incremental cost and effectiveness of inpatient THA compared to outpatient THA over a lifetime horizon. Effectiveness was expressed in quality-adjusted life years (QALYs). Costs, expressed in 2019 US dollars, transition probabilities, and health utilities were derived from the literature. The primary outcome was the incremental cost-effectiveness ratio (ICER), with a willingness to pay (WTP) threshold set at $50,000/QALY. 1-way and probabilistic sensitivity analyses was performed to evaluate the effect of the various variables on the model.
In the base case, inpatient THA was more effective in terms of total utility (10.36 vs. 10.30 QALY), but also more costly ($48,155 ± 1673 vs. $43,288 ± 1, 606 for Medicare) than outpatient THA. Even with a lifetime horizon, the ICER was $81,116 per QALY and $140,917 per QALY for Medicare and private payer insurance, respectively, which is higher than the willingness to pay threshold. 1-way sensitivity analyses indicated that the variables having the most influence on the model were the utility of inpatient and outpatient THA and cost of inpatient and outpatient THA.
This model determined that for a WTP threshold set at $50,000/QALY, outpatient THA is more cost-effective than inpatient THA from a societal perspective. Despite this, surgeons must weigh clinical factors first and foremost in determining if an individual patient can be safely operated on in the outpatient setting.
本研究旨在对美国门诊与住院全髋关节置换术（THA）进行成本效果分析，同时考虑并发症概率及其潜在成本。
本研究从社会角度出发，采用成本效果分析方法，对终生范围内门诊与住院 THA 的增量成本和效果进行评估。效果以质量调整生命年（QALY）表示。成本以 2019 年美元表示，转移概率和健康效用则取自文献。主要结果为增量成本效果比（ICER），设定支付意愿（WTP）阈值为 50000 美元/QALY。进行单因素敏感性分析和概率敏感性分析，以评估模型中各变量对结果的影响。
在基准情况下，住院 THA 在总效用方面（10.36 比 10.30 QALY）更有效，但也更昂贵（医疗保险为 48155 美元±1673 美元，私人保险为 43288 美元±1606 美元）。即便采用终生分析，门诊 THA 的增量成本效果比也分别为每 QALY81116 美元和每 QALY140917 美元，医疗保险和私人保险均高于支付意愿阈值。单因素敏感性分析表明，对模型影响最大的变量为门诊和住院 THA 的效用及门诊和住院 THA 的成本。
该模型确定，在设定支付意愿阈值为 50000 美元/QALY 的情况下，从社会角度来看，门诊 THA 比住院 THA 更具成本效果。尽管如此，外科医生在决定是否可以安全地将患者安排在门诊进行手术时，仍需首先考虑临床因素。
