Christofilopoulos Panayiotis, Bothorel Hugo, Bilger Selina, Rüter Florian, Cody Robyn, Stoffel Karl
Department of Trauma and Orthopaedic Surgery, La Tour Hospital, 1217 Meyrin, Switzerland.
Research Department, La Tour Hospital, 1217 Meyrin, Switzerland.
J Clin Med. 2025 May 9;14(10):3310. doi: 10.3390/jcm14103310.
Total hip arthroplasty (THA) is a highly effective treatment for end-stage hip disease, but the increasing volume of procedures demands a focus on value-based healthcare (VBHC) to ensure optimal outcomes. This study proposes a novel approach to evaluate the value delivered by THA using direct costs and patient-reported outcome measures (PROMs). : This retrospective cohort study included patients undergoing primary THA for unilateral osteoarthritis at two hospitals between 2018 and 2021. PROMs specific to hip osteoarthritis were assessed preoperatively and in the second postoperative year. The delivered was calculated using PROM results in comparison with the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds. The associated was defined as direct THA expenses in comparison with the median direct costs of the cohort series, and the was calculated as the ratio of over . A multivariable linear regression was performed to identify the factors associated with the THA . : Among 224 patients (70 ± 10 years, 46% males), THA was of satisfactory (≥1.0) for 82%. The THA was lower for patients of female sex (β -0.27, = 0.047), with higher preoperative PROMs (β -0.36, < 0.001), previous contralateral THA (β -0.36, = 0.049), or ipsilateral hip surgery (β -1.41, < 0.001) with custom (β -0.76, = 0.011) or fully cemented (β -0.83, = 0.021) implants. : The proposed methodology effectively assessed the THA value, revealing satisfactory outcomes for most patients but also identifying areas for improvement. These findings emphasize the need for risk-adjusted VBHC models to enhance equity and efficiency in arthroplasty care.
全髋关节置换术（THA）是治疗终末期髋关节疾病的一种高效方法，但手术量的不断增加要求关注基于价值的医疗保健（VBHC）以确保最佳疗效。本研究提出了一种新方法，使用直接成本和患者报告的结局指标（PROMs）来评估THA所带来的价值。：这项回顾性队列研究纳入了2018年至2021年间在两家医院接受单侧骨关节炎初次THA的患者。在术前和术后第二年评估了针对髋骨关节炎的PROMs。通过将PROM结果与最小临床重要差异（MCID）和患者可接受症状状态（PASS）阈值进行比较来计算所带来的价值。相关成本定义为THA直接费用与队列系列中位数直接成本的比较，而价值效益比计算为价值与成本的比率。进行多变量线性回归以确定与THA价值效益比相关的因素。：在224例患者（70±10岁，46%为男性）中，82%的患者THA的价值效益比令人满意（≥1.0）。女性患者的THA价值效益比更低（β -0.27，P = 0.047），术前PROMs更高（β -0.36，P <0.001），既往对侧THA（β -0.36，P = 0.049），或同侧髋关节手术（β -1.41，P <0.001），使用定制（β -0.76，P = 0.011）或全骨水泥（β -0.83，P = 0.021）植入物。：所提出的方法有效地评估了THA的价值，揭示了大多数患者的满意疗效，但也确定了需要改进的领域。这些发现强调了需要风险调整的VBHC模型来提高关节置换护理的公平性和效率。
