The Library

Cost-effectiveness of total hip arthroplasty versus resurfacing arthroplasty : economic evaluation alongside a clinical trial

Tools

Edlin, Richard P., Tubeuf, Sandy, 1978-, Achten, Juul, Parsons, Nicholas R. and Costa, Matthew L.. (2012) Cost-effectiveness of total hip arthroplasty versus resurfacing arthroplasty : economic evaluation alongside a clinical trial. BMJ Open, Volume 2 (Number 5). Article:e001162. ISSN 2044-6055

This is the latest version of this item.

Preview

Text
WRAP_Achten_BMJ Open-2012-Edlin-.pdf - Published Version
Available under License ["licenses_description_cc_by_nc_2" not defined].
Download (375Kb) | Preview

Official URL: http://dx.doi.org/10.1136/bmjopen-2012-001162

Abstract

Objective: To report on the relative cost-effectiveness of total hip arthroplasty and resurfacing arthroplasty (replacement of articular surface of femoral head only) in patients with severe arthritis suitable for hip joint resurfacing arthroplasty.

Design: Cost-effectiveness analysis on an intention-to-treat basis of a single-centre, single-blind randomised controlled trial of 126 adult patients within 12 months of treatment. Missing data were imputed using multiple imputations with differences in baseline quality of life and gender adjusted using regression techniques.

Setting: A large teaching hospital trust in the UK.

Participants: A total of 126 adult patients with severe arthritis of the hip joint suitable for a resurfacing arthroplasty of the hip.

Results: Data were received for 126 patients, 4 of whom did not provide any resource use data. For the remainder, data were imputed for costs or quality of life in at least one time point (baseline, 3, 6 months and 1 year) for 18 patients. Patients in the resurfacing arm had higher quality of life at 12 months (0.795 vs 0.727) and received 0.032 more QALYs within the first 12 months postoperation. At an additional cost of £564, resurfacing arthroplasty offers benefits at £17 451 per QALY within the first 12 months of treatment. When covariates are considered, the health economic case is stronger in men than in women.

Conclusions: Resurfacing arthroplasty appears to offer very short-term efficiency benefits over total hip arthroplasty within a selected patient group. The short-term follow-up in this trial should be noted, particularly in light of the concerns raised regarding adverse reactions to metal debris from metal-on-metal bearing surfaces in the longer term. Longer-term follow-up of resurfacing arthroplasty patients and decision analytic modelling is also advised.

Trial registration Current controlled Trials: ISRCTN33354155. UKCRN 4093.

Item Type:

Journal Article

Subjects:

R Medicine > R Medicine (General)
R Medicine > RD Surgery

Divisions:

Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit

Library of Congress Subject Headings (LCSH):

Total hip replacement -- Great Britain, Arthroplasty -- Great Britain, Medical care, Cost of -- Great Britain, Great Britain. National Health Service, Clinical trials -- Great Britain

Series Name:

Working Paper Series of the Academic Unit of Health Economics, Leeds Institute of Health Science, University of Leeds

Journal or Publication Title:

BMJ Open

Publisher:

BMJ

Place of Publication:

Leeds

ISSN:

2044-6055

Official Date:

12 October 2012

Dates:

Date	Date Type
12 October 2012	Published
17 August 2012	Accepted
29 March 2012	Submitted

Volume:

Volume 2

Number:

Number 5

Page Range:

Article:e001162

Identification Number:

10.1136/bmjopen-2012-001162

Status:

Peer Reviewed

Publication Status:

Published

Access rights to Published version:

Open Access

Funder:

National Institute for Health Research (Great Britain) (NIHR)

Grant number:

PB-PG-0706-10080

References:

1. Health Episodes Statistics Online. Finalised PROMs data 2009–10,
2011.
2. Health Episodes Statistics Online. PROMs Score Comparisons April
2009 to February 2011: The NHS Information Centre for Health and
Social Care, 2011.
3. Ellams D, Forsyth O, Mistry A, et al. 7th Annual Report. National
Joint Registry for England and Wales; 2010.
4. Garellick G, Kärrholm J, Rogmark C, et al. Swedish Hip Arthroplasty
Register: Annual Report 2008. Shortened Version. Department of
Orthopaedics, Sahlgrenska University Hospital; 2009.
5. Bozic KJ, Morshed S, Silverstein MD, et al. Use of
cost-effectiveness analysis to evaluate new technologies in
orthopaedics: the case of alternative bearing surfaces in total hip
arthroplasty. J Bone Joint Surg 2006;88:706–14.
6. Briggs A, Sculpher M, Dawson J, et al. Modelling the
cost-effectiveness of primary hip replacement: how cost-effective is
the Spectron compared to the Charnley prosthesis? CHE Technical
Paper Series 28. York: University of York, 2003:51.
7. Fitzpatrick R, Shortall E, Sculpher M, et al. Modelling of
cost-effectiveness of THR: methods and results and
discussion in primary total hip replacement surgery: a
systematic review of outcomes and modelling of
cost-effectiveness associated with different prostheses. Health
Technol Assess 1998;2:17–32.
8. Vale L,Wyness L, McCormack K, et al. A systematic review of the
effectiveness and cost-effectiveness of metal-on-metal hip resurfacing
arthroplasty for treatment of hip disease. Health Technol Assess 2002;6(15).
9. Bozic KJ, Pui CM, Ludeman MJ, et al. Do the potential benefits of
metal-on-metal resurfacing justify the increased cost and risk of
complications? Clin Orthop Relat Res 2010;468:2301–12.
10. Achten JA, Parsons NR, Edlin RE, et al. A randomised controlled
trial of total hip arthroplasty versus resurfacing arthroplasty in the
treatment of young patients with arthritis of the hip joint. BMC
Musculoskelet Disord 2010;11(8).
11. Costa ML, Achten J, Parsons NR, et al. Total hip arthroplasty versus
resurfacing arthroplasty in the treatment of young patients with
arthritis of the hip joint: a single centre, parallel group, assessor
blind, randomised control trial. BMJ 2012;344:e2147.
12. Curtis L. Unit Costs of Health & Social Care 2010. Personal and
Social Services Research Unit, 2010:1–253.
13. Dolan P. Modeling valuations for EuroQol health. Med Care
1997;35:1095–108.
14. HRG version 3.5 & HRG4 Comparative Chapter Analysis: The
Health & Social Care Information Centre, 2008.
15. Department of Health. National Schedule of Reference Costs
2009–10. Appendix NSRC04: NHS Trusts and PCTs combined
reference cost schedules. London: Crown Copyright, 2011.
16. NHS. Electronic Drug Tariff: May 2011. National Health Service
England and Wales, 2011.
17. White IR, Royston P, Wood AM. Multiple imputation using chained
equations: issues and guidance for practice. Stat Med
2011;30:377–99.
18. Royston P. Multiple imputation of missing values: further update of
ice, with an emphasis on interval censoring. Stata J
2007;7:445–64.
19. Royston P, Carlin JB, White IR. Multiple imputation of missing
values: new features for mim. Stata J 2009;9:252–64.
20. Fenwick E, Byford S. A guide to cost-effectiveness acceptability
curves. Br J Psychiatry 2005;187:106–8.
21. Gioe TJ, Sharma A, Tatman P, et al. Do ‘premium’ joint implants add
value? Clin Orthop Relat Res 2011;469:48–54.
22. Petrou S, Gray A. Economic evaluation using decision analytical
modelling: decision, conduct, analysis, and reporting. BMJ
2011;342. doi: 10.1136/bmj.d766
23. de Steiger RN, Miller LN, Prosser GH, et al. Poor outcome of
revised resurfacing hip arthroplasty. 397 cases from the Australian
Joint Replacement Registry. Acta Orthop 2010;81:72–6.
24. Kärrholm J, Garellick G, Rogmark C, et al. Swedish Hip Arthroplasty
Register: Annual Report 2007. Department of Orthopaedics,
Sahlgrenska University Hospital, 2008.