title: Modeling the cost-effectiveness for cement-less and hybrid prosthesis in total hip replacement in Emilia Romagna, Italy.
abstract: BACKGROUND
  The aim of the present study was to assess the cost-effectiveness of cement-less versus hybrid prostheses in total hip replacement (THR) in patients diagnosed with primary osteoarthritis.
  
  
  METHODS
  Effectiveness data were obtained from the Emilia-Romagna Regional Registry on Orthopaedic Prosthesis (RIPO), which collects information on all orthopaedic intervention performed in Emilia-Romagna (41,199 total hip replacements performed from 2000 to 2007), and from which we obtained survival curves and transition probabilities for the cement-less and hybrid prostheses, respectively. Conversely, costs were derived from regional databases through a specific procedure, which allowed us to register individual component's costs for both primary and subsequent revision interventions. A specific Markov transition model was constructed in order to consider the 3 types of revisions that an implant could possibly undergo through its life-span: total, cup or stem, head insert or neck. The cost-effectiveness was expressed in terms of cost per "revision-free" life year.
  
  
  CONCLUSIONS
  Considering a 70-y old patient undergoing THR, the cementless strategy resulted more effective but more costly than the hybrid solution, with an incremental cost effectiveness ratio of 2401.63 € per revision-free life year. Following a deterministic sensitivity analysis, hybrid and cementless fixation showed, respectively, a dominance profile for patients older than 83 y and younger than 43 y, whereas for all ages in between, we report a progressive increase in the ICER of cementless prostheses. Our results proved to be robust, as underlined by the probabilistic sensitivity analysis performed using cost distributions.
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Italy. gianluca.ditanna@uniroma1.it
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Di Tanna
authors.forename: Salvatore
authors.initials: S
authors.lastname: Ferro
authors.forename: Filippo
authors.initials: F
authors.lastname: Cipriani
authors.forename: Barbara
authors.initials: B
authors.lastname: Bordini
authors.forename: Susanna
authors.initials: S
authors.lastname: Stea
authors.forename: Aldo
authors.initials: A
authors.lastname: Toni
authors.forename: Federico
authors.initials: F
authors.lastname: Silipo
authors.forename: Giampiero
authors.initials: G
authors.lastname: Pirini
authors.forename: Roberto
authors.initials: R
authors.lastname: Grilli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000379:methods*; D001843:Bone Cements; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D006622:Hip Prosthesis; D006801:Humans; D007558:Italy; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D010003:Osteoarthritis / Q000191:economics / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies
chemical_list: D001843:Bone Cements