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

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Edlin, Richard P., Tubeuf, Sandy, 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

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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

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

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