From the Los Angeles Bone and Joint Institute, Encino, CA (Sheibani-Rad); the Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Kuhn); the School of Public Policy, University of Calgary, Calgary, Alberta, Canada (Berrigan), and the Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI (Bedi).
J Am Acad Orthop Surg. 2021 Dec 15;29(24):e1353-e1361. doi: 10.5435/JAAOS-D-21-00166.
Compared with hemiarthroplasty (HA), reverse total shoulder arthroplasty (RTSA) may provide greater cost and health-related benefits for patients with complex three- and four-part proximal humeral fractures. This study set out to compare RTSA versus HA for the incremental cost per incremental improvement in quality adjusted life years (QALYs) for a hypothetical cohort of patients with proximal humerus fractures.
Parameters and characteristics for a hypothetical cohort of elderly patients with proximal humerus fractures were collected through the literature. A cohort-level Markov decision model was constructed. Incremental cost-effectiveness ratios representing the difference in cost divided by the difference in QALYs were calculated, and scenario, one-way, and probabilistic analysis were conducted.
RTSA was associated with lower cost and greater effectiveness compared with HA. The predicted cost difference corresponded to a saving of $99,626 per 100 individuals treated, and the predicted difference in QALY was 16.8 per 100 individuals treated. Results were sensitive to the discount rate, the health-related quality of life assigned to health states, and the cost of the surgical procedures. In probabilistic analysis, 77.1% of iterations were cost-effective at a threshold willingness-to-pay for a QALY of $100,000 US dollars.
Findings suggest that RTSA may be a cost-effective alternative to HA for treating elderly patients requiring surgery for proximal humerus fractures.
The model and corresponding code are available on request to the corresponding author.
Level III.
与半髋关节置换术（HA）相比，反式全肩关节置换术（RTSA）可为复杂的三部分和四部分肱骨近端骨折患者提供更大的成本和健康相关益处。本研究旨在比较 RTSA 与 HA 对于肱骨近端骨折患者假设队列的增量成本每增加质量调整生命年（QALYs）的增量成本效益比。
通过文献收集了肱骨近端骨折老年患者假设队列的参数和特征。构建了一个队列水平的马尔可夫决策模型。计算了代表成本差异除以 QALY 差异的增量成本效益比，并进行了情景、单向和概率分析。
与 HA 相比，RTSA 具有更低的成本和更高的效果。预测的成本差异相当于每 100 人治疗节省 99626 美元，预测的 QALY 差异为每 100 人治疗 16.8 个。结果对贴现率、分配给健康状况的健康相关生活质量以及手术成本敏感。在概率分析中，77.1%的迭代在 10 万美元的 QALY 支付意愿阈值下具有成本效益。
研究结果表明，对于需要接受肱骨近端骨折手术的老年患者，RTSA 可能是 HA 的一种具有成本效益的替代方案。
模型和相应的代码可应要求提供给通讯作者。
三级。
