A cost-effectiveness assessment of dual-mobility bearings in revision hip arthroplasty

Abstract

Aims The rate of dislocation when traditional single bearing implants are used in revision total hip arthroplasty (THA) has been reported to be between 8% and 10%. The use of dual mobility bearings can reduce this risk to between 0.5% and 2%. Dual mobility bearings are more expensive, and it is not clear if the additional clinical benefits constitute value for money for the payers. We aimed to estimate the cost-effectiveness of dual mobility compared with single bearings for patients undergoing revision THA. Methods We developed a Markov model to estimate the expected cost and benefits of dual mobility compared with single bearing implants in patients undergoing revision THA. The rates of revision and further revision were calculated from the National Joint Registry of England and Wales, while rates of transition from one health state to another were estimated from the literature, and the data were stratified by sex and age. Implant and healthcare costs were estimated from local procurement prices and national tariffs. Quality-adjusted life-years (QALYs) were calculated using published utility estimates for patients undergoing THA. Results At a minimum five-year follow-up, the use of dual mobility was cost-effective with an estimated incremental cost-effectiveness ratio (ICER) of between £3,006 and £18,745/QALY for patients aged < 55 years and between 64 and 75 years, respectively. For those aged > 75 years dual mobility was only cost-effective if the timeline was beyond seven years. The use of dual mobility bearings was cost-saving for patients aged < 75 years and cost-effective for those aged > 75 years if the time horizon was beyond ten years. Conclusion The use of dual mobility bearings is cost-effective compared with single bearings in patients undergoing revision THA. The younger the patient is, the more likely it is that a dual mobility bearing can be more cost-effective and even cost-saving. The results are affected by the time horizon and cost of bearings for those aged > 75 years. For patients aged > 75 years, the surgeon must decide whether the use of a dual mobility bearing is a viable economic and clinical option. Cite this article: Bone Joint J 2020;102-B(9):1128–1135.

Cost-effectiveness of dual-mobility components in patients with displaced femoral neck fractures

“…One-year cycles were considered a realistic clinical period in which revisions are likely to occur, based on previous publications. 22,25 The model assumes that not all dislocations will result in revision surgery; rather, a proportion of patients would be successfully managed by closed reduction. 19,26 Patients undergoing revision surgery will remain at risk of a subsequent revision (re-revision).…”

“…Previously published evidence on the cost-effectiveness of DM-THA has been limited to primary THA for arthritis, 20 inclusive of all indications for THA 21 or limited exclusively to revision THA. 22,23 The purpose of this study is to assess the cost-effectiveness of DM-THA compared with SB-THA among adult patients with displaced hip fractures.…”

Advances and innovations in total hip arthroplasty

“…Dual mobility cups provide a greater range of motion, a greater head-to-neck ratio, and a greater jump distance, resulting in a lower risk of instability [ 102 , 103 ]. Dual-mobility cups decrease the rate of dislocation in primary and revision THA [ 104 ]. Concerns with dual-mobility cups include increased wear and intra-prosthetic dislocation [ 105 ].…”

“…Furthermore, dual mobility bearings constitute a reliable treatment option to enhance hip stability and appear to have been widely adopted in THA in dysplastic patients and revision THA for instability [ 4 ]. As well as this, a recent cost-effectiveness analysis, utilising a Markov model in patients undergoing revision THA has shown that dual mobility implants in patients under 75 are cost-saving [ 5 ]. It has been suggested that the systematic use of dual mobility cups may induce substantial cost-savings compared to THA with a fixed bearing, even in primary THA [ 6 ].…”

Reconstruction after resection of a proximal humeral tumour

“…The use of inexpensive spacers has been reported to give similar function and satisfaction as the use of an endoprosthesis. 32,33 With healthcare systems worldwide under pressure due to costconstraints, 34,35 surgeons must be able to justify using costly endoprostheses to provide optimal function over a considerable period of time.…”