背景:髋部骨折是一种常见且代价高昂的健康问题,导致显著的发病率和死亡率,以及医疗保健系统的高成本,尤其是老年人。实施手术预防策略有可能改善生活质量并减轻医疗资源负担,特别是在长期。然而,目前,标准化髋部骨折预防措施的指南有限.
方法:本研究使用具有有限状态马尔可夫模型和队列模拟的成本效益分析来评估老年人髋部骨折的一级和二级手术预防。在两种不同的模型(A和B)中模拟了60至90岁的患者,以评估不同水平的预防。模型A假定在对侧骨折手术期间进行了预防,而模型B包括具有高骨折危险因素的个体。费用是从医疗保险和医疗补助服务中心获得的,过渡概率和健康状态效用来自现有文献。基线假设是预防后骨折风险降低10%。还进行了敏感性分析,以评估结果的可靠性和变异性。
结果:骨折风险降低10%,模型A的成本在每个质量调整生命年8,850美元至46,940美元($/QALY)之间。此外,事实证明,它在61至81岁的年龄范围内最具成本效益。敏感性分析确定,预防需要降低≥2.8%才能绝对具有成本效益。二级预防水平的成本效益对对侧预防的成本最敏感,病人的年龄,和骨折治疗费用。对于无骨折史的高危患者,预防策略的成本效益取决于其风险状况。在基线分析中,一级预防水平的增量成本效益比在11,000美元/QALY和74,000美元/QALY之间变化,低于确定的支付意愿门槛。
结论:由于髋部骨折的治疗费用高,发病率增加,手术预防策略已经证明,它们可以显著缓解医疗保健系统。各种关键假设促进了建模,为不确定性留出足够的空间。需要进一步的研究来评估与健康状态相关的风险。
BACKGROUND: Hip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices.
METHODS: This study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results.
RESULTS: With a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side\'s prophylaxis, the patient\'s age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold.
CONCLUSIONS: Due to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks.