title: Cost effectiveness of total hip arthroplasty in osteoarthritis: comparison of devices with differing bearing surfaces and modes of fixation.
abstract: Many different designs of total hip arthroplasty (THA) with varying performance and cost are available. The identification of those which are the most cost-effective could allow significant cost-savings. We used an established Markov model to examine the cost effectiveness of five frequently used categories of THA which differed according to bearing surface and mode of fixation, using data from the National Joint Registry for England and Wales. Kaplan-Meier analyses of rates of revision for men and women were modelled with parametric distributions. Costs of devices were provided by the NHS Supply Chain and associated costs were taken from existing studies. Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and the probability of a device being cost effective at a willingness to pay £20 000/QALY were included in the models. The differences in QALYs between different categories of implant were extremely small (< 0.0039 QALYs for men or women over the patient's lifetime) and differences in cost were also marginal (£2500 to £3000 in the same time period). As a result, the probability of any particular device being the most cost effective was very sensitive to small, plausible changes in quality of life estimates and cost. Our results suggest that available evidence does not support recommending a particular device on cost effectiveness grounds alone. We would recommend that the choice of prosthesis should be determined by the rate of revision, local costs and the preferences of the surgeon and patient.
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: R
authors.initials: R
authors.lastname: Pulikottil-Jacob
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: M
authors.initials: M
authors.lastname: Connock
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: N-B
authors.initials: NB
authors.lastname: Kandala
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: H
authors.initials: H
authors.lastname: Mistry
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: A
authors.initials: A
authors.lastname: Grove
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: K
authors.initials: K
authors.lastname: Freeman
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: M
authors.initials: M
authors.lastname: Costa
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: P
authors.initials: P
authors.lastname: Sutcliffe
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: A
authors.initials: A
authors.lastname: Clarke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000295:instrumentation; D001843:Bone Cements; D002484:Cementation; D003362:Cost-Benefit Analysis; D005260:Female; D006622:Hip Prosthesis / Q000191:economics*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D012042:Registries
chemical_list: D001843:Bone Cements
keywords: Hip arthroplasty; cost-effectiveness; hip replacement; osteoarthritis