Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Front Public Health. 2022 Apr 25;10:825727. doi: 10.3389/fpubh.2022.825727. eCollection 2022.
Total hip arthroplasty (THA) causes a great medical burden globally, and the same-day discharge (SDD) method has previously been considered to be cost saving. However, a standard cost-effectiveness analysis (CEA) in a randomized controlled trial (RCT) is needed to evaluated the benefits of SDD when performing THA from the perspective of both economic and clinical outcomes.
Eighty-four participants undergoing primary THA were randomized to either the SDD group or the inpatient group. Outcomes were assessed by an independent orthopedist who was not in the surgical team, using the Oxford Hip Score (OHS), EuroQol 5D (EQ-5D), SF-36 scores and the quality-adjusted life years (QALYs). All the cost information was also collected.
The mean stay of patients in the SDD group was 21.70 ± 3.45 h, while the inpatient group was 78.15 ± 26.36 h. This trial did not detect any significant differences in OHS and QALYs. The total cost in the SDD group was significantly lower than that in the inpatient group (¥69,771.27 ± 6,608.00 vs. ¥80,666.17 ± 8,421.96, < 0.001). From the perspective of total cost, when measuring OHS, the incremental effect was -0.12 and the incremental cost was -¥10,894.90. The mean incremental cost-effectiveness ratio (ICER) was 90,790.83. When measuring QALYs, the incremental effect was 0.02, and the ICER was negative. Sensitivity analysis produced similar results.
SDD has an acceptable likelihood of being more cost-effective than the traditional inpatient option. After conducting cost-utility analysis, SDD resulted in better QALYs, while significantly reducing the total cost.
全髋关节置换术（THA）在全球范围内造成了巨大的医疗负担，而当日出院（SDD）方法此前被认为具有成本效益。然而，需要从经济和临床结果的角度进行一项针对 THA 的随机对照试验（RCT）的标准成本效益分析（CEA），以评估 SDD 的益处。
84 名接受初次 THA 的患者被随机分配到 SDD 组或住院组。由不参与手术团队的独立骨科医生使用牛津髋关节评分（OHS）、欧洲五维健康量表（EQ-5D）、SF-36 评分和质量调整生命年（QALYs）评估结果。还收集了所有成本信息。
SDD 组患者的平均住院时间为 21.70 ± 3.45 小时，而住院组为 78.15 ± 26.36 小时。本试验未发现 OHS 和 QALYs 有任何显著差异。SDD 组的总费用明显低于住院组（¥69,771.27 ± 6,608.00 比 ¥80,666.17 ± 8,421.96， < 0.001）。从总费用的角度来看，在测量 OHS 时，增量效应为-0.12，增量成本为-¥10,894.90。平均增量成本效益比（ICER）为 90,790.83。在测量 QALYs 时，增量效应为 0.02，ICER 为负值。敏感性分析得出了相似的结果。
SDD 更有可能比传统的住院选择更具成本效益。进行成本效益分析后，SDD 导致更好的 QALYs，同时显著降低了总费用。
