title: Economic evaluation of NSAID and radiation to prevent heterotopic ossification after hip surgery.
abstract: BACKGROUND
  Heterotopic ossification (HO) is a known complication in hip surgery, but there is still uncertainty whether to use non-steroidal anti-inflammatory drugs (NSAID) or radiation in its prevention. While the literature focuses almost exclusively on (as it turns out the lacking) difference in effectiveness, one important difference that has been widely unacknowledged thus far is cost-effectiveness.
  
  
  METHODS
  We systematically reviewed the literature to extract evidence-based estimates of treatment effectiveness, complications, and associated costs. These variables are combined in a decision tree to calculate costs for all potential outcomes and tested in sensitivity analyses. Finally, the incremental cost-effectiveness ratio (ICER) was calculated. Data on the effectiveness of both treatments could be extracted from nine randomized controlled trails and one meta-analysis.
  
  
  RESULTS
  Across the 95% confidence interval for the risk difference of HO despite treatment radiation is either dominated by NSAID, which are cheaper and more effective, or has an ICER of US$ 5,858.93 per additionally prevented case of HO.
  
  
  CONCLUSIONS
  Among the studied variables that might affect cost-effectiveness, the rate of complications requiring treatment was by far the most influential.
authors.affiliation: Department of Orthopedic Surgery, Children's Hospital Boston, Harvard Medical School, MA 02115, USA. patrick.vavken@childrens.harvard.edu
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
authors.forename: Ronald
authors.initials: R
authors.lastname: Dorotka
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006615:Hip / Q000601:surgery*; D006801:Humans; D019637:Orthopedic Procedures; D009999:Ossification, Heterotopic / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011878:Radiotherapy / Q000191:economics*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal