title: Is hip arthroscopy cost-effective for femoroacetabular impingement?
abstract: BACKGROUND
  The impact of hip arthroscopy on health-related quality of life (HRQoL) among younger patients with symptomatic femoroacetabular impingement (FAI) is unknown, but with increasing recognition of the condition there is likely to be increasing demand for arthroscopy.
  
  
  OBJECTIVE
  We describe an approach to determine the incremental cost-effectiveness of hip arthroscopy compared with observation in patients with FAI; we also identified variables that influence its cost-effectiveness.
  
  
  METHODS
  We constructed a Markov model including possible health states for 36-year-old patients with FAI using decision analysis software and compared two strategies: (1) observation and (2) hip arthroscopy, followed by THA with disease progression. We estimated the ratio of the incremental cost to the incremental benefit (reflected by HRQoL) of both strategies. We identified studies reporting Harris hip scores and complications after arthroscopy to estimate health state preferences and their probabilities. We performed sensitivity analyses on 30 input variables over a plausible range of estimates to determine the influence of uncertainty on the ICER with particular emphasis on the magnitude and duration of benefit.
  
  
  RESULTS
  Among patients with FAI but no radiographic evidence of arthritis, the estimated ICER of hip arthroscopy was $21,700/QALY while the ICER for patients with preoperative arthritis was $79,500/QALY. Alteration of the natural history of arthritis by hip arthroscopy improved the ICER to $19,200/QALY and resulted in cost savings if THA was not performed until at least 16 years after arthroscopy.
  
  
  CONCLUSIONS
  Although limited by available data, our model suggests hip arthroscopy in patients with FAI without arthritis may result in a favorable ICER compared with other health interventions considered cost-effective. Further studies of hip arthroscopy are needed to determine the impact on quality of life, duration of symptomatic relief, and the effect on the need for subsequent THA.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320-W, San Francisco, CA 94143, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Shearer
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kramer
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
authors.forename: Brian T
authors.initials: BT
authors.lastname: Feeley
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D018803:Models, Economic; D015207:Osteoarthritis, Hip / Q000191:economics* / Q000601:surgery; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome