Cost-effectiveness of Same-day Discharge Surgery for Primary Total Hip Arthroplasty: A Pragmatic Randomized Controlled Study

Frontiers in Public Health

article

Yangyang Shi¹  Peipei Zhu¹  Jie Jia¹  Zengwu Shao¹  Shuhua Yang¹  Wei Chen²  Ke Zhang³  Wei Tong¹  Hongtao Tian¹ 

[1] Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology;The Third Hospital of Hebei Medical University;Biostatistician at Causality Clinical Data Technology Co., Ltd.

关键词: total hip arthroplasty;    same-day discharge surgery;    efficacy;    cost-effectiveness;    quality of life;   

DOI  :  10.3389/fpubh.2022.825727

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Total hip arthroplasty (THA) causes a great medical burden globally, and the same-day discharge (SDD) method has previously been considered to be cost saving. However, a standard cost-effectiveness analysis (CEA) in a randomized controlled trial (RCT) is needed to evaluated the benefits of SDD when performing THA from the perspective of both economic and clinical outcomes. Methods Eighty-four participants undergoing primary THA were randomized to either the SDD group or the inpatient group. Outcomes were assessed by an independent orthopedist who was not in the surgical team, using the Oxford Hip Score (OHS), EuroQol 5D (EQ-5D), SF-36 scores and the quality-adjusted life years (QALYs). All the cost information was also collected. Results The mean stay of patients in the SDD group was 21.70 ± 3.45 h, while the inpatient group was 78.15 ± 26.36 h. This trial did not detect any significant differences in OHS and QALYs. The total cost in the SDD group was significantly lower than that in the inpatient group (¥69,771.27 ± 6,608.00 vs. ¥80,666.17 ± 8,421.96, p < 0.001). From the perspective of total cost, when measuring OHS, the incremental effect was −0.12 and the incremental cost was –¥10,894.90. The mean incremental cost-effectiveness ratio (ICER) was 90,790.83. When measuring QALYs, the incremental effect was 0.02, and the ICER was negative. Sensitivity analysis produced similar results. Conclusions SDD has an acceptable likelihood of being more cost-effective than the traditional inpatient option. After conducting cost–utility analysis, SDD resulted in better QALYs, while significantly reducing the total cost.

【 授权许可】

CC BY