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Using Patient-Reported Outcomes for Economic Evaluation: Getting the Timing Right

  • Chris Schilling
    Correspondence
    Address correspondence to: C. Schilling, Centre for Health Policy, the University of Melbourne, 207 Bouverie Street, Carlton 3051, Australia.
    Affiliations
    Centre for Health Policy, School of Population and Global Health, the University of Melbourne, Carlton, Victoria, Australia

    The University of Melbourne Department of Surgery, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
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  • Michelle M. Dowsey
    Affiliations
    The University of Melbourne Department of Surgery, St. Vincent’s Hospital, Fitzroy, Victoria, Australia

    Department of Orthopaedics, St. Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
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  • Philip M. Clarke
    Affiliations
    Centre for Health Policy, School of Population and Global Health, the University of Melbourne, Carlton, Victoria, Australia
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  • Peter F. Choong
    Affiliations
    The University of Melbourne Department of Surgery, St. Vincent’s Hospital, Fitzroy, Victoria, Australia

    Department of Orthopaedics, St. Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
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      Abstract

      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.

      Keywords

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