A cost-effectiveness analysis after implementation of a fast-track protocol for total knee arthroplasty
| Autor: | Jeroen Kruidenier, Barbara A.M. Snoeker, Bea Spek, Joris A. Jansen |
|---|---|
| Přispěvatelé: | Master Evidence Based Practice, APH - Methodology |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Cost-effectiveness study Cost-Benefit Analysis medicine.medical_treatment Fast-track pathway 03 medical and health sciences 0302 clinical medicine Quality of life Surveys and Questionnaires Humans Medicine Quality-adjusted life years Orthopedics and Sports Medicine Postoperative Period 030212 general & internal medicine Hospital Costs Arthroplasty Replacement Knee Enhanced recovery Aged Retrospective Studies Protocol (science) 030222 orthopedics business.industry Retrospective cohort study Evidence-based medicine Cost-effectiveness analysis Length of Stay Arthroplasty Surgery Quality-adjusted life year Total knee replacement Total knee arthroplasty Quality of Life Female Fast track business Follow-Up Studies |
| Zdroj: | Knee, 27(2), 451-458. Elsevier |
| ISSN: | 0968-0160 |
| DOI: | 10.1016/j.knee.2019.09.014 |
| Popis: | Background Since the introduction of arthroplasty fast-track protocols, many studies have investigated their effect on complications and length of hospital stay. However, few fast-track studies have examined the long-term effects on cost and health-related quality of life after total knee arthroplasty (TKA). This study aimed to specifically analyze, after implementation of fast-track TKA, cost-effectiveness with functional outcome, length of stay, thromboembolic complications, medical costs, and quality of life after 12 months. Methods A retrospective cohort of 403 TKA patients treated by a fast-track pathway were compared with 283 patients in a non-fast-track pathway. Length of stay and thromboembolic complications were registered postoperatively. Healthcare costs were based on hospital production costs and calculated on average. Costs were compared with EQ-5D questionnaires to derived quality-adjusted life year (QALY) scores. Results No between-protocol differences were found in functional outcome and quality of life after TKA. The fast-track protocol reduced the length of stay from a median five days to median three days, and did not influence the thromboembolic complication rate (2.6%). After one-year follow-up for fast-track pathway patients, QALY was 0.85 vs. 0.84 for non-fast-track. A reduction of 268,- euro per patient was calculated in favor of the fast-track protocol. Conclusion Fast-track protocol implementation is a cost-effective strategy for patients undergoing TKA, with high QALY and reduced costs. Fast-track TKA treatment is safe, with low thromboembolic complications. This is the first study to measure fast-track implementation effects on functional outcome and quality of life up to 12 months postoperatively, and calculate equivalent QALYs for both groups. Level of evidence Level III. |
| Databáze: | OpenAIRE |
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