Latessa Imma, Ricciardi Carlo, Jacob Deborah, Jónsson Halldór, Gambacorta Monica, Improta Giovanni, Gargiulo Paolo
University Hospital of Naples "Federico II", Department of Public Health, Naples, Italy; Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík.
Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík, Iceland; University Hospital of Naples 'Federico II', Department of Advanced Biomedical Sciences, Naples.
Eur J Transl Myol. 2021 Mar 9;31(1):9651. doi: 10.4081/ejtm.2021.9651.
The purpose of this study is to use Health Technology Assessment (HTA) through the Six Sigma (SS) and DMAIC (Define, Measure, Analyse, Improve, Control) problem-solving strategies for comparing cemented and uncemented prostheses in terms of the costs incurred for Total hip arthroplasty (THA) and the length of hospital stay (LOS). Multinomial logistic regression analysis for modelling the data was also performed. Quantitative parameters extracted from gait analysis, electromyography and computed tomography images were used to compare the approaches, but the analysis did not show statistical significance. The variables regarding costs were studied with the Mann-Whitney and Kruskal-Wallis tests. No statistically significant difference between cemented and uncemented prosthesis for the total cost of LOS was found, but the cost of the surgeon had an influence on the overall expenses, affecting the cemented prosthetic approach. The material costs of surgery for the uncemented prosthesis and the cost of theatre of surgery for the cemented prosthesis were the most influential. Multinomial logistic regression identified the Vastus Lateralis variable as statistically significant. The overall accuracy of the model is 93.0%. The use of SS and DMAIC cycle as tools of HTA proved that the cemented and uncemented approaches for THA have similar costs and LOSy.
本研究的目的是通过六西格玛（SS）和DMAIC（定义、测量、分析、改进、控制）问题解决策略运用卫生技术评估（HTA），以比较全髋关节置换术（THA）中骨水泥型和非骨水泥型假体在成本和住院时间（LOS）方面的差异。还对数据进行了多项逻辑回归分析以建立模型。从步态分析、肌电图和计算机断层扫描图像中提取的定量参数用于比较不同方法，但分析未显示出统计学意义。使用曼-惠特尼检验和克鲁斯卡尔-沃利斯检验研究了与成本相关的变量。在LOS总成本方面，骨水泥型和非骨水泥型假体之间未发现统计学上的显著差异，但外科医生的费用对总费用有影响，影响了骨水泥型假体的手术方式。非骨水泥型假体的手术材料成本和骨水泥型假体的手术室成本影响最大。多项逻辑回归确定股外侧肌变量具有统计学意义。该模型的总体准确率为93.0%。使用SS和DMAIC循环作为HTA工具证明，THA的骨水泥型和非骨水泥型手术方式在成本和LOS方面相似。
