老年肱骨近端骨折手术和保守治疗的成本效果分析

Surgical and non-surgical treatment for elderly patients with proximal humeral fracture: a cost-effectiveness analysis

目的比较老年肱骨近端骨折手术和保守治疗的临床疗效和总体费用,并利用成本效果分析的方法对两种治疗方案进行对比研究。方法将2013年1月至2014年12月期间于我院接受治疗的67例老年肱骨近端骨折患者纳入研究,按治疗方式分为手术组(37例)和保守组(30例)。手术组患者均接受三角肌-胸大肌入路切开复位内固定术,保守组患者均给予超肩小夹板及颈腕吊带固定。根据我院病案科资料、电话随访及标准费用法统计患者伤后1年因骨折产生的总体费用。末次随访时采用Neer评分评估患者肩关节功能,并利用成本效果分析的方法计算两组患者的成本效果比和增量成本效果比。结果手术和保守患者1年内总体费用分别为53 864元和8 826.9元,肩关节Neer评分分别为79.1分和72.1分。成本效果分析显示手术和保守患者关节功能每提高1分需分别花费681元和122.4元,与保守治疗相比手术患者Neer评分每多增加1分需多花费6 433.9元。结论保守治疗与切开复位内固定术治疗老年肱骨近端骨折短期内疗效均较为满意,但保守治疗的总体费用明显偏低,是更经济、有效的治疗方案。

Objective To analyze the health economics effects of surgical and non-surgical treatment for proximal humeral fracture with cost-effectiveness analysis(CEA) and provide treatment advice for clinical work. Method From January 2013 to December 2014 a total of 67 elderly patients with proximal humeral fracture were admitted and divided into 2 groups according to the treatment plan. There were 37 cases in surgical group and 30 cases in non-surgical group respectively. The total costs due to fracture were collected for 1 year after injury. We applied Neer scores to evaluate the clinical outcome for the patients in different groups. At the last follow-up both the data of costs and effect were used to calculate the cost effectiveness ratio(CER) and incremental cost effectiveness ratio(ICER). Results After 1 year follow-up, the total costs of operation and conservative treatment were CNY 53 864 and CNY 8 826.9, and the Neer score was 79.1 for patients in surgical group and 72.1 in non-surgical group respectively. The CER showed that patients in surgical group and non-surgical group needed to spend CNY 681 and CNY 122.4 for each Neer score. The ICER showed patients underwent operation needed to spend extra CNY 6433.9 for each Neer score than that without surgery. Conclusion Although surgery can provide better outcome than conservative treatment, the total costs were also higher obviously. From health economics perspective conservative treatment may be more cost-effective than surgical treatment in China.