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Cost effectiveness of total hip arthroplasty in osteoarthritis : comparison of devices with differing bearing surfaces and modes of fixation
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Pulikottil-Jacob, Ruth, Connock, M., Kandala, Ngianga-Bakwin, Mistry, Hema, Grove, Amy L., Freeman, Karoline, Costa, Matthew L., Sutcliffe, P. (Paul) and Clarke, Aileen (2015) Cost effectiveness of total hip arthroplasty in osteoarthritis : comparison of devices with differing bearing surfaces and modes of fixation. Bone & Joint Research, Volume 97 (Number 4). pp. 449-457. doi:10.1302/0301-620X.97B4.34242 ISSN 2046-3758.
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Official URL: http://dx.doi.org/10.1302/0301-620X.97B4.34242
Abstract
Many different designs of total hip arthroplasty (THA) with varying performance and cost are available. The identification of those which are the most cost-effective could allow significant cost-savings. We used an established Markov model to examine the cost effectiveness of five frequently used categories of THA which differed according to bearing surface and mode of fixation, using data from the National Joint Registry for England and Wales. Kaplan–Meier analyses of rates of revision for men and women were modelled with parametric distributions. Costs of devices were provided by the NHS Supply Chain and associated costs were taken from existing studies. Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and the probability of a device being cost effective at a willingness to pay £20 000/QALY were included in the models.
The differences in QALYs between different categories of implant were extremely small (< 0.0039 QALYs for men or women over the patient’s lifetime) and differences in cost were also marginal (£2500 to £3000 in the same time period). As a result, the probability of any particular device being the most cost effective was very sensitive to small, plausible changes in quality of life estimates and cost.
Our results suggest that available evidence does not support recommending a particular device on cost effectiveness grounds alone. We would recommend that the choice of prosthesis should be determined by the rate of revision, local costs and the preferences of the surgeon and patient.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Subjects: | R Medicine > RC Internal medicine | ||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Total hip replacement -- Cost effectiveness -- Mathematical models , Surgery, Surgeons, Patients, Medical care, Cost of | ||||
| Journal or Publication Title: | Bone & Joint Research | ||||
| Publisher: | British Editorial Society of Bone and Joint Surgery | ||||
| ISSN: | 2046-3758 | ||||
| Official Date: | April 2015 | ||||
| Dates: |
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| Volume: | Volume 97 | ||||
| Number: | Number 4 | ||||
| Page Range: | pp. 449-457 | ||||
| DOI: | 10.1302/0301-620X.97B4.34242 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access | ||||
| Funder: | NIHR Health Technology Assessment Programme (Great Britain), University Hospitals Birmingham NHS Foundation Trust | ||||
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