科研之友
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摘要
Background: Patient-reported outcome measures (PROMS) are becoming increasingly popular in orthopedic surgery. Preoperative and postoperative follow-up often elicit PROMS in the form of generic quality-of-life instruments (e.g., Short Form health survey SF-12 [SF-12]) that can be used in economic evaluation to estimate quality-adjusted life-years (QALYs). However, the timing of postoperative measurement is still under debate. Objectives: To explore the timing of postoperative PROMS collection and the implications for bias in QALY estimation for economic evaluation. Methods: We compared the accuracy of QALY estimation on the basis of utilities derived from the SF-12 at one of 6 weeks, 3 months, 6 months, and 12 months after total knee arthroplasty, under different methods of interpolation between points. Five years of follow-up data were extracted from the St. Vincent's Melbourne Arthroplasty Outcomes (SMART) registry (n = 484). The SMART registry collects follow-up PROMS annually and obtained more frequent outcomes on subset of patients (n = 133). Results: Postoperative PROM collection at 6 weeks, 6 months, or 12 months biased the estimation of QALY gain from total knee arthroplasty by-41% (95% confidence interval [CI]-59% to-22%), 18% (95% CI 4%-32%), and-8% (95% CI-18% to-2%), respectively. This bias was minimized by collecting PROMS at 3 months postoperatively (6% error; 95% CI-9% to 21%). Conclusions: The timing of PROM collection and the interpolation assumptions between measurements can bias economic evaluation. In the case of total knee arthroplasty, we recommend a postoperative measurement at 3 months with linear interpolation between preoperative and postoperative measures. The design of economic evaluations should consider timing and interpolation issues.
- 出版日期2016-12
