Health Economics and Market Access, DePuy Synthes, Leeds, UK.
Medical Devices Epidemiology, Real World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA.
J Med Econ. 2021 Jan-Dec;24(1):10-18. doi: 10.1080/13696998.2020.1854989.
To estimate 2-year healthcare resource utilization (HCRU) and costs of dislocation following primary total hip arthroplasty (THA).
This retrospective evaluation used medical claims from the US Medicare database. Patients were eligible if they were ≥65 years old, underwent a primary elective inpatient THA between 1 January 2010 and 31 December 2016 (index), and had continuous Medicare coverage and enrollment ≥365 days prior to index (baseline). Exclusion criteria were prior THA, concomitant infection, non-Medicare primary payer, or enrolled in Medicare due to end-stage renal disease. One- and 2-year HCRU and costs across all service types and settings of care excluding retail pharmacy were evaluated. Propensity score matching and direct matching adjusted for confounding.
Among Medicare patients who underwent THA and met inclusion criteria ( = 450,355; mean age ∼74, and two-thirds female), 7,680 (1.7%) had a hip dislocation. After matching, 4,551 patients without and 4,551 patients with dislocation were selected. Percentage utilization, mean days of service, and claims payments amounts were significantly greater for patients with vs without THA dislocation for variables such as THA hospitalization, home health agency, skilled nursing facility, inpatient rehabilitation facility, other inpatient admission, long-term care hospital, and outpatient care. Findings were consistent for 1- and 2-year follow-up, although differences were more pronounced for 1-year. Per-patient-cost increases with dislocation were $19,590 over 1 year and $24,211 over 2 years. Two-thirds of the cost increase was due to other inpatient admission and the remaining one-third was due to skilled nursing facility, outpatient, inpatient rehabilitation facility, and home health agency costs.
Administrative claims are not collected for research and lack clinical information. Results may not be generalizable to other patients or settings of care.
This large US retrospective database study demonstrated the substantial HCRU and cost burden of THA dislocation.
评估初次全髋关节置换术后（THA）脱位后 2 年的医疗资源利用（HCRU）和成本。
本回顾性评估使用了美国医疗保险数据库中的医疗索赔数据。如果患者年龄≥65 岁，在 2010 年 1 月 1 日至 2016 年 12 月 31 日期间接受了初次择期住院 THA（索引），并且在索引前（基线）有连续的医疗保险覆盖和登记≥365 天，则符合条件。排除标准为既往 THA、合并感染、非医疗保险主要支付人，或因终末期肾病而参加医疗保险。评估了所有类型的医疗服务和护理环境（不包括零售药店）的 1 年和 2 年 HCRU 和成本。采用倾向评分匹配和直接匹配来调整混杂因素。
在接受 THA 并符合纳入标准的医疗保险患者中（n=450355；平均年龄约为 74 岁，三分之二为女性），有 7680 例（1.7%）发生髋关节脱位。匹配后，选择了 4551 例无脱位和 4551 例有脱位的患者。与无 THA 脱位的患者相比，THA 住院、家庭健康机构、熟练护理设施、住院康复设施、其他住院入院、长期护理医院和门诊护理等变量的患者利用率、平均服务天数和理赔支付金额显著更高。1 年和 2 年的随访结果一致，尽管 1 年的差异更为明显。1 年和 2 年的脱位患者人均成本分别增加了 19590 美元和 24211 美元。成本增加的三分之二归因于其他住院入院，其余三分之一归因于熟练护理设施、门诊、住院康复设施和家庭健康机构的费用。
行政索赔并非为研究而收集，缺乏临床信息。结果可能不适用于其他患者或护理环境。
这项来自美国的大型回顾性数据库研究表明，THA 脱位给医疗资源利用和成本带来了巨大的负担。
