Cost of radiotherapy versus NSAID administration for prevention of heterotopic ossification after total hip arthroplasty.
OBJECTIVE
Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned.


METHODS
We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau.


RESULTS
The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930.


CONCLUSIONS
If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered.
Strauss
Jonathan B
JB
Department of Radiation Oncology, Rush University Medical Center, 500 S. Paulina, Chicago, IL 60612, USA. Jonathan_Strauss@rush.edu
Chen
Sea S
SS
Shah
Anand P
AP
Coon
Alan B
AB
Dickler
Adam
A
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics; D003362:Cost-Benefit Analysis; D004526:Efficiency; D006471:Gastrointestinal Hemorrhage / Q000191:economics* / Q000209:etiology; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015442:Medicare Assignment; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000191:economics / Q000517:prevention & control*; D011878:Radiotherapy / Q000191:economics*; D012086:Reoperation / Q000191:economics; D014481:United States
D000894:Anti-Inflammatory Agents, Non-Steroidal