衰弱的机构化老年患者股骨近端骨折的非手术与手术治疗：一项成本-效用分析及多中心前瞻性队列研究。
Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study.
机构信息
Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands.
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
出版信息
Osteoporos Int. 2023 Mar;34(3):515-525. doi: 10.1007/s00198-022-06638-x. Epub 2023 Jan 7.
UNLABELLED
Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term quality of life. Nonoperative management of hip fractures in patients at the end of life should be openly discussed with SDM.
PURPOSE
The aim was to describe healthcare use with associated costs and to determine cost-utility of nonoperative management (NOM) versus operative management (OM) of frail institutionalized older patients with a proximal femoral fracture.
METHODS
This study included institutionalized patients with a limited life expectancy aged ≥ 70 years who sustained a proximal femoral fracture in the Netherlands. Costs of hospital- and nursing home care were calculated. Quality adjusted life years (QALY) were calculated based on EuroQol-5D-5L utility scores at day 7, 14, and 30 and at 3 and 6 months. The incremental cost-effectiveness ratio (ICER) was calculated from a societal perspective.
RESULTS
Of the 172 enrolled patients, 88 (51%) patients opted for NOM and 84 (49%) for OM. NOM was associated with lower healthcare costs at 6 months (NOM; €2425 (SD 1.030), OM; €9325 (SD 4242), p < 0.001). The main cost driver was hospital stay (NOM; €738 (SD 841) and OM; €3140 (SD 2636)). The ICER per QALY gained in the OM versus NOM was €76,912 and exceeded the threshold of €20,000 per QALY. The gained QALY were minimal in the OM group in patients who died within 14- and 30-day post-injury, but OM resulted in more than triple the costs.
CONCLUSION
OM results in significant higher healthcare costs, mainly due to the length of hospital stay. For frail patients at the end of life, NOM of proximal femoral fractures should be openly discussed in SDM conversations due to the limited gain in QoL.
TRIAL REGISTRATION
Netherlands Trial Register (NTR7245; date 10-06-2018).
非手术治疗与手术治疗对衰弱的机构化老年股骨近端骨折患者的比较
荷兰的一项成本效用研究
摘要
髋部骨折与大量医疗保健费用有关。在脆弱的机构化患者中，非手术治疗的成本低于手术治疗，且短期生活质量相当。对于生命末期的患者，应与 SDM 公开讨论髋部骨折的非手术治疗。
目的
本研究旨在描述医疗保健的使用情况及其相关费用，并确定衰弱的机构化老年患者股骨近端骨折行非手术治疗（NOM）与手术治疗（OM）的成本-效用。
方法
本研究纳入了预期寿命有限、年龄≥70 岁的机构化患者，这些患者在荷兰发生了股骨近端骨折。计算了住院和疗养院护理的费用。根据 EuroQol-5D-5L 效用评分，在第 7、14 和 30 天以及 3 和 6 个月时计算了质量调整生命年（QALY）。从社会角度计算了增量成本效益比（ICER）。
结果
在纳入的 172 名患者中，88 名（51%）患者选择 NOM，84 名（49%）患者选择 OM。NOM 在 6 个月时的医疗保健费用较低（NOM：€2425（SD 1.030），OM：€9325（SD 4242），p<0.001）。主要的成本驱动因素是住院费用（NOM：€738（SD 841），OM：€3140（SD 2636））。OM 相对于 NOM 的每 QALY 增量成本为€76912，超过了每 QALY 20000 欧元的阈值。在受伤后 14 天和 30 天内死亡的 OM 组患者中，获得的 QALY 很少，但 OM 导致的成本却增加了两倍多。
结论
OM 导致了显著更高的医疗保健费用，主要是由于住院时间延长。对于生命末期的脆弱患者，应在 SDM 对话中公开讨论股骨近端骨折的 NOM，因为 QoL 的改善有限。
临床试验注册
荷兰试验注册处（NTR7245；日期为 2018 年 6 月 10 日）。
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