University of Virginia School of Medicine, Charlottesville, Virginia.
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
J Arthroplasty. 2024 Sep;39(9S1):S299-S305.e9. doi: 10.1016/j.arth.2024.02.054. Epub 2024 Feb 24.
New technologies in hip and knee arthroplasty are commonly evaluated using cost-effectiveness analyses and similar economic assessments. There is a wide variation in the methodology of these studies, introducing the potential for bias. The purpose of this study was to evaluate associations between potential financial conflicts of interest (COI) and the outcomes of economic analyses. We hypothesized that authors' COI and industry funding would be associated with conclusions favorable to a new technology.
Economic analyses making cost-effectiveness or economic implementation claims on patient-specific instrumentation, robotics, and implants used in hip and knee arthroplasty published from 2010 to 2022 were identified. Papers were evaluated to determine if conclusions were favorable to the new technology being studied. Fisher's exact test was utilized to determine the relationship between the presence of COI and an article's conclusions.
Of 43 eligible articles, 76.7% were cost-effectiveness analyses, 23.2% were cost analyses, and 67.4% of articles had conclusions favorable to a technology. Of the 29 articles with favorable conclusions, 26 had an author with a financial COI (89.7%), and 14 had industry funding (48.3%). Of the 33 articles with a financial COI, 26 (78.8%) had favorable conclusions, and of the 16 articles with industry funding, 14 (87.5%) had favorable conclusions. Fisher's exact test revealed a statistically significant association between an article having favorable conclusions and the presence of an author's COI or industry funding (odds ratio, 13.5; 95% CI [confidence interval], 2.3 to 79.9; P = .003).
Financial COIs were present in 79.1% of lower extremity arthroplasty economic analyses on technologies and were associated with an article having conclusions favorable to the new technology. Surgeons and decision-makers should be aware of the variability and assumptions in these studies and the potential bias of the conclusions.
新的髋关节和膝关节置换技术通常通过成本效益分析和类似的经济评估进行评估。这些研究的方法存在很大差异，因此存在潜在的偏差。本研究旨在评估潜在财务利益冲突（COI）与经济分析结果之间的关系。我们假设作者的 COI 和行业资金与新技术有利的结论相关。
确定了 2010 年至 2022 年期间发表的关于髋关节和膝关节置换术中使用的特定于患者的仪器、机器人和植入物的成本效益分析或经济实施的经济分析文章。评估论文以确定结论是否有利于正在研究的新技术。利用 Fisher 精确检验确定 COI 的存在与文章结论之间的关系。
在 43 篇合格的文章中，76.7%为成本效益分析，23.2%为成本分析，67.4%的文章结论有利于某种技术。在 29 篇有有利结论的文章中，有 26 篇（89.7%）的作者有财务 COI，有 14 篇（48.3%）的文章有行业资金。在有财务 COI 的 33 篇文章中，有 26 篇（78.8%）的文章结论有利，在有行业资金的 16 篇文章中，有 14 篇（87.5%）的文章结论有利。Fisher 精确检验表明，文章结论有利与作者 COI 或行业资金的存在之间存在统计学显著关联（优势比，13.5；95%置信区间 [置信区间]，2.3 至 79.9；P =.003）。
在关于新技术的下肢关节置换术经济分析中，财务 COI 存在于 79.1%的分析中，并且与文章对新技术有利的结论相关。外科医生和决策者应该意识到这些研究的变异性和假设以及结论的潜在偏差。
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