title: Has Metal-On-Metal Resurfacing Been a Cost-Effective Intervention for Health Care Providers?-A Registry Based Study.
abstract: BACKGROUND
  Total hip replacement for end stage arthritis of the hip is currently the most common elective surgical procedure. In 2007 about 7.5% of UK implants were metal-on-metal joint resurfacing (MoM RS) procedures. Due to poor revision performance and concerns about metal debris, the use of RS had declined by 2012 to about a 1% share of UK hip procedures. This study estimated the lifetime cost-effectiveness of metal-on-metal resurfacing (RS) procedures versus commonly employed total hip replacement (THR) methods.
  
  
  RESULTS
  We performed a cost-utility analysis using a well-established multi-state semi-Markov model from an NHS and personal and social services perspective. We used individual patient data (IPD) from the National Joint Registry (NJR) for England and Wales on RS and THR surgery for osteoarthritis recorded from April 2003 to December 2012. We used flexible parametric modelling of NJR RS data to guide identification of patient subgroups and RS devices which delivered revision rates within the NICE 5% revision rate benchmark at 10 years. RS procedures overall have an estimated revision rate of 13% at 10 years, compared to <4% for most THR devices. New NICE guidance now recommends a revision rate benchmark of <5% at 10 years. 60% of RS implants in men and 2% in women were predicted to be within the revision benchmark. RS devices satisfying the 5% benchmark were unlikely to be cost-effective compared to THR at a standard UK willingness to pay of £20,000 per quality-adjusted life-year. However, the probability of cost effectiveness was sensitive to small changes in the costs of devices or in quality of life or revision rate estimates.
  
  
  CONCLUSIONS
  Our results imply that in most cases RS has not been a cost-effective resource and should probably not be adopted by decision makers concerned with the cost effectiveness of hip replacement, or by patients concerned about the likelihood of revision, regardless of patient age or gender.
authors: Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Ruth
authors: R
authors: Pulikottil-Jacob
authors: Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Martin
authors: M
authors: Connock
authors: Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.|Northumbria University, Department of Mathematics, Physics and Electrical Engineering, Faculty of Engineering and Environment, Newcastle upon Tyne, United Kingdom.
authors: Ngianga-Bakwin
authors: NB
authors: Kandala
authors: Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Hema
authors: H
authors: Mistry
authors: Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Amy
authors: A
authors: Grove
authors: Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Karoline
authors: K
authors: Freeman
authors: Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Matthew
authors: M
authors: Costa
authors: Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Paul
authors: P
authors: Sutcliffe
authors: Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Aileen
authors: A
authors: Clarke
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis / Q000191:economics*; D004739:England; D005260:Female; D006282:Health Personnel / Q000191:economics*; D006622:Hip Prosthesis / Q000191:economics; D006801:Humans; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000191:economics*; D008670:Metals; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery / Q000628:therapy; D011474:Prosthesis Design / Q000191:economics / Q000379:methods; D011475:Prosthesis Failure; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D014852:Wales
chemical_list: D008670:Metals