The use of patient-reported outcome measures to guide referral for hip and knee arthroplasty
| Autor: | H, Dakin, P, Eibich, D, Beard, A, Gray, A, Price |
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| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
Male Arthroplasty Replacement Hip Cost-Benefit Analysis Joint arthroplasty Osteoarthritis Hip Arthroplasty Return to Work Osteoarthritis Humans Revision Knee Arthroplasty Knee Patient Reported Outcome Measures Arthroplasty Replacement Knee Revision Hip Arthroplasty Referral and Consultation health care economics and organizations Aged Probability Hip Activity Level Cost-utility analysis Middle Aged Osteoarthritis Knee musculoskeletal system Markov Chains United Kingdom Economic evaluation surgical procedures operative Female Quality-Adjusted Life Years |
| Zdroj: | The Bone & Joint Journal |
| ISSN: | 2049-4408 |
| Popis: | Aims To assess how the cost-effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) varies with age, sex, and preoperative Oxford Hip or Knee Score (OHS/OKS); and to identify the patient groups for whom THA/TKA is cost-effective. Methods We conducted a cost-effectiveness analysis using a Markov model from a United Kingdom NHS perspective, informed by published analyses of patient-level data. We assessed the cost-effectiveness of THA and TKA in adults with hip or knee osteoarthritis compared with having no arthroplasty surgery during the ten-year time horizon. Results THA and TKA cost < £7,000 per quality-adjusted life-year (QALY) gained at all preoperative scores below the absolute referral thresholds calculated previously (40 for OHS and 41 for OKS). Furthermore, THA cost < £20,000/QALY for patients with OHS of ≤ 45, while TKA was cost-effective for patients with OKS of ≤ 43, since the small improvements in quality of life outweighed the cost of surgery and any subsequent revisions. Probabilistic and one-way sensitivity analyses demonstrated that there is little uncertainty around the conclusions. Conclusion If society is willing to pay £20,000 per QALY gained, THA and TKA are cost-effective for nearly all patients who currently undergo surgery, including all patients at and above our calculated absolute referral thresholds. Cite this article: Bone Joint J 2020;102-B(7):950–958. |
| Databáze: | OpenAIRE |
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