Enhanced recovery following hip and knee arthroplasty: a systematic review of cost-effectiveness evidence.
BMJ Open
; 10(1): e032204, 2020 01 15.
Article
em En
| MEDLINE
| ID: mdl-31948987
ABSTRACT
OBJECTIVES:
To assess cost-effectiveness of enhanced recovery pathways following total hip and knee arthroplasties. Secondary objectives were to report on quality of studies and identify research gaps for future work.DESIGN:
Systematic review of cost-utility analyses. DATA SOURCES Ovid MEDLINE, Embase, the National Health Service Economic Evaluations Database and EconLit, January 2000 to August 2019. ELIGIBILITY CRITERIA English-language peer-reviewed cost-utility analyses of enhanced recovery pathways, or components of one, compared with usual care, in patients having total hip or knee arthroplasties for osteoarthritis. DATA EXTRACTION ANDSYNTHESIS:
Data extracted by three reviewers with disagreements resolved by a fourth. Study quality assessed using the Consensus on Health Economic Criteria list, the International Society for Pharmacoeconomics and Outcomes Research and Assessment of the Validation Status of Health-Economic decision models tools; for trial-based studies the Cochrane Collaboration's tool to assess risk of bias. No quantitative synthesis was undertaken.RESULTS:
We identified 17 studies five trial-based and 12 model-based studies. Two analyses evaluated entire enhanced recovery pathways and reported them to be cost-effective compared with usual care. Ten pathway components were more effective and cost-saving compared with usual care, three were cost-effective, and two were not cost-effective. We had concerns around risk of bias for all included studies, particularly regarding the short time horizon of the trials and lack of reporting of model validation.CONCLUSIONS:
Consistent results supported enhanced recovery pathways as a whole, prophylactic systemic antibiotics, antibiotic-impregnated cement and conventional ventilation for infection prevention. No other interventions were subject of more than one study. We found ample scope for future cost-effectiveness studies, particularly analyses of entire recovery pathways and comparison of incremental changes within pathways. A key limitation is that standard practices have changed over the period covered by the included studies. PROSPERO REGISTRATION NUMBER CRD42017059473.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Modelos Econômicos
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Artroplastia de Quadril
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Artroplastia do Joelho
/
Recuperação Pós-Cirúrgica Melhorada
Tipo de estudo:
Health_economic_evaluation
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Prognostic_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article