大腿骨臼蓋インピンジメント症候群および関節唇断裂の治療における股関節鏡の費用対効果：システマティックレビュー【股関節唇損傷論文紹介#3】

題名
Abstract
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コンディショニングケア機器の紹介

題名

Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

大腿骨臼蓋インピンジメント症候群および関節唇断裂の治療における股関節鏡の費用対効果。システマティックレビュー

PubMed

外部リンク

Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impin…

https://pubmed.ncbi.nlm.nih.gov/34250156/

In the majority of the studies, hip arthroscopy had a higher initial cost but provided greater gain in QALYs than did a nonoperative treatment. In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection. However, there is further …

Abstract

原文

Background: Hip arthroscopy has frequently been shown to produce successful outcomes as a treatment for femoroacetabular impingement (FAI) and labral tears. However, there is less literature on whether the favorable results of hip arthroscopy can justify the costs, especially when compared with a nonoperative treatment.

Purpose: To systematically review the cost-effectiveness of hip arthroscopy for treating FAI and labral tears.

Study design: Systematic review; Level of evidence, 3.

Methods: PubMed/MEDLINE, Embase, and Cochrane Library databases, and the Tufts University Cost-Effectiveness Analysis Registry were searched to identify articles that reported the cost per quality-adjusted life-year (QALY) generated by hip arthroscopy. The key terms used were “hip arthroscopy,” “cost,” “utility,” and “economic evaluation.” The threshold for cost-effectiveness was set at $50,000/QALY. The Methodological Index for Non-Randomized Studies instrument and Quality of Health Economic Studies (QHES) score were used to determine the quality of the studies. This study was prospectively registered on PROSPERO (CRD42020172991).

Results: Six studies that reported the cost-effectiveness of hip arthroscopy were identified, and 5 of these studies compared hip arthroscopy to a nonoperative comparator. These studies were found to have a mean QHES score of 85.2 and a mean cohort age that ranged from 33-37 years. From both a health care system perspective and a societal perspective, 4 studies reported that hip arthroscopy was more costly but resulted in far greater gains than did nonoperative treatment. The preferred treatment strategy was most sensitive to duration of benefit, preoperative osteoarthritis, cost of the arthroscopy, and the improvement in QALYs with hip arthroscopy.

Conclusion: In the majority of the studies, hip arthroscopy had a higher initial cost but provided greater gain in QALYs than did a nonoperative treatment. In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection. However, there is further need for literature to analyze willingness-to-pay thresholds.

Keywords: cost-effectiveness; femoroacetabular impingement; hip arthroscopy.

翻訳文

概要

背景股関節鏡は大腿骨臼蓋インピンジメント（FAI）や臼蓋部断裂の治療法として成功することがしばしば示されてきた．しかし、特に非手術的治療と比較した場合、股関節鏡手術の良好な結果が費用を正当化できるかどうかについての文献は少ない。

目的

FAIと関節唇裂傷の治療に対する股関節鏡の費用対効果を系統的に検討する。

研究デザイン

システマティックレビュー；エビデンスレベル、3。

方法

PubMed/MEDLINE、Embase、Cochrane Libraryデータベース、およびTufts University Cost-Effectiveness Analysis Registryを検索し、股関節鏡検査によって生じた質調整生存年（QALY）あたりのコストを報告した論文を特定した。キーワードは、”股関節鏡”、”コスト”、”効用”、”経済評価 “とした。費用対効果の閾値は、$50,000/QALYとした。研究の質の判定には、Methodological Index for Non-Randomized Studies instrumentとQuality of Health Economic Studies（QHES）スコアが用いられた。本研究はPROSPEROにプロスペクティブに登録された（CRD42020172991）。

結果

結果は以下の通り。股関節鏡手術の費用対効果を報告した研究が6件確認され、そのうち5件は股関節鏡手術と非手術の比較対象との比較であった。これらの研究は、平均QHESスコアが85.2、平均コホート年齢が33～37歳であったことが分かった。医療システムの観点と社会の観点の両方から、4つの研究で、股関節鏡はコストが高いが、非手術治療よりもはるかに大きな利益をもたらすと報告された。好ましい治療戦略は、有益性の持続期間、術前の変形性関節症、関節鏡のコスト、および股関節鏡によるQALYsの改善に最も敏感であった。