Cost-effectiveness analysis of periacetabular osteotomy.
BACKGROUND
A lack of long-term outcomes data following periacetabular osteotomy makes it difficult for surgeons to recommend the most appropriate procedure to young patients who might be candidates for a joint-preserving procedure. In this study, we compared the cost-effectiveness of periacetabular osteotomy with total hip arthroplasty in terms of cost per quality-adjusted life year for the young adult.


METHODS
A decision model was constructed for a cost-utility analysis of periacetabular osteotomy compared with total hip arthroplasty. Outcome probabilities and effectiveness were derived from the literature. Effectiveness was expressed in quality-adjusted life years gained. Cost data were compiled and verified from our institution. Costs and utilities were discounted in accord with the United States Panel on Cost-Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and net health benefits. Multivariate sensitivity analysis was used to assess the contribution of included variables in the model's outcomes.


RESULTS
For Tönnis grade-1 coxarthrosis, periacetabular osteotomy dominates with an average incremental cost-effectiveness of $7856 per quality-adjusted life year and an average incremental effectiveness of 0.15. For Tönnis grade-2 coxarthrosis, periacetabular osteotomy is, on the average, more cost-effective than total hip arthroplasty with an incremental cost-effectiveness of $824 per quality-adjusted life year, but it is less effective than total hip arthroplasty, on the average, with an incremental effectiveness of -1.4 quality-adjusted life years. Periacetabular osteotomy becomes more cost-effective at a longevity of 5.5 years for Tönnis grade-1 coxarthrosis and 18.25 years for Tönnis grade-2 coxarthrosis. In Tönnis grade-3 coxarthrosis, total hip replacement becomes the dominant treatment strategy.


CONCLUSIONS
Periacetabular osteotomy is, on the average, more cost-effective in Tönnis grade-1 and grade-2 coxarthrosis, while it is both more costly and less effective in Tönnis grade-3 coxarthrosis. These findings can inform clinical decision-making in the absence of long-term data. On the basis of this model, periacetabular osteotomy is preferable to total hip arthroplasty in Tönnis grade-1 and grade-2 coxarthrosis when the patient is sufficiently young and when functionality in sports is important.
Sharifi
Emile
E
School of Medicine, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA.
Sharifi
Husham
H
Morshed
Saam
S
Bozic
Kevin
K
Diab
Mohammad
M
D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006618:Hip Dislocation, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000209:etiology / Q000601:surgery*; D010027:Osteotomy / Q000191:economics* / Q000379:methods; D011788:Quality of Life