Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.
J Arthroplasty. 2023 Jul;38(7 Suppl 2):S84-S90. doi: 10.1016/j.arth.2023.02.067. Epub 2023 Mar 5.
Patients infected with the hepatitis C virus (HCV) have high complication rates following total hip arthroplasty (THA). Advances in HCV therapy now enable clinicians to eradicate the disease; however, its cost-effectiveness from an orthopaedic perspective remains to be demonstrated. We sought to conduct a cost-effectiveness analysis comparing no therapy to direct-acting antiviral (DAA) therapy prior to THA among HCV-positive patients.
A Markov model was utilized to evaluate the cost-effectiveness of treating HCV with DAA prior to THA. The model was powered with event probabilities, mortality, cost, and quality-adjusted life year (QALY) values for patients with and without HCV that were obtained from the published literature. This included treatment costs, successes of HCV eradication, incidences of superficial or periprosthetic joint infection (PJI), probabilities of utilizing various PJI treatment modalities, PJI treatment success/failures, and mortality rates. The incremental cost-effectiveness ratio was compared to a willingness-to-pay threshold of $50,000/QALY.
Our Markov model indicates that in comparison to no therapy, DAA prior to THA is cost-effective for HCV-positive patients. THA in the setting of no therapy and DAA added 8.06 and 14.39 QALYs at a mean cost of $28,800 and $115,800. The incremental cost-effectiveness ratio associated with HCV DAA in comparison to no therapy was $13,800/QALY, below the willingness-to-pay threshold of $50,000/QALY.
Hepatitis C treatment with DAA prior to THA is cost-effective at all current drug list prices. Given these findings, strong consideration should be given to treating patients for HCV prior to elective THA.
Cost-effectiveness Analysis; Level III.
感染丙型肝炎病毒（HCV）的患者在接受全髋关节置换术（THA）后并发症发生率较高。HCV 治疗的进步使临床医生能够消除该疾病；然而，从骨科角度来看，其成本效益仍有待证明。我们试图进行一项成本效益分析，比较 HCV 阳性患者在接受 THA 之前不进行治疗与直接作用抗病毒（DAA）治疗的情况。
采用马尔可夫模型评估 DAA 治疗 HCV 在前的 THA 的成本效益。该模型采用了来自已发表文献的 HCV 患者和非 HCV 患者的事件概率、死亡率、成本和质量调整生命年（QALY）值来进行计算。这包括治疗成本、HCV 根除成功率、浅表或假体周围关节感染（PJI）的发生率、各种 PJI 治疗方式的使用概率、PJI 治疗的成功/失败率以及死亡率。增量成本效益比与 50,000 美元/QALY 的支付意愿阈值进行了比较。
我们的马尔可夫模型表明，与不治疗相比，DAA 在前的 THA 对 HCV 阳性患者具有成本效益。在不治疗和 DAA 治疗的情况下，THA 分别增加了 8.06 和 14.39 个 QALY，平均成本分别为 28,800 美元和 115,800 美元。与不治疗相比，HCV DAA 的增量成本效益比为 13,800 美元/QALY，低于 50,000 美元/QALY 的支付意愿阈值。
在目前所有药物定价下，DAA 治疗 HCV 在前的 THA 具有成本效益。鉴于这些发现，强烈考虑在接受择期 THA 之前对患者进行 HCV 治疗。
成本效益分析；三级。
