Best Thomas M, Petterson Stephanie, Plancher Kevin
Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami, Coral Gables, FL, USA.
Orthopaedic Foundation, Stamford, CT, USA.
J Orthop Surg Res. 2020 Oct 19;15(1):481. doi: 10.1186/s13018-020-01987-x.
Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management.
A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost-effectiveness plot comparing SAM treatment vs. SOC was also generated using 1000 iterations of the model. Lastly, the incremental cost-effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC).
Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8641 and 0.52 versus SOC at: $6281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-min session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2276. Incremental cost-effectiveness demonstrated that most of the time (84%) SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC.
In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤ $50,000, it appears that SAM is a cost-effective treatment for knee OA.
被诊断为骨关节炎（OA）且出现症状的患者正在寻求保守治疗方案，以减轻疼痛、改善功能并避免手术。持续声学医学（SAM），一种长达数小时的治疗方法，已证明对膝骨关节炎患者有更好的临床效果。本分析的目的是比较在6个月时间内，长达数小时的SAM治疗与标准治疗（SOC）在OA症状管理方面的成本和效果。
采用决策树分析来比较SAM治疗与SOC在OA患者中的成本和效果。OA治疗成功的概率和效果是通过系统评价和荟萃分析从文献中得出的。成本来自医疗保险支付率和制造商价格。功能效果通过与SOC治疗途径相比的治疗效果大小和治疗途径来衡量。进行敏感性分析以确定哪些成本变量对决定哪种选择成本最低影响最大。还使用该模型的1000次迭代生成了比较SAM治疗与SOC的增量成本效果图。最后，增量成本效果比（ICER）计算为（SAM成本减去SOC成本）除以（SAM功能效果减去SOC功能效果）。
基础病例表明，在6个月内，SAM的成本和功能效果分别为8641美元和0.52，而SOC分别为6281美元和0.39。敏感性分析表明，为了使SAM成为成本较低的选择，每15分钟物理治疗疗程的成本需要大于88美元，或者SAM的定价需要小于或等于2276美元。增量成本效果表明，大多数时候（84%），SAM治疗导致功能效果改善，但成本高于SOC。
在骨关节炎患者中，与SOC相比，SAM治疗显示出疼痛和功能改善，但成本增加。基于SAM治疗的ICER评分≤50000美元，SAM似乎是膝OA的一种具有成本效益的治疗方法。
