An international comparative study of total hip arthroplasty cost and practice patterns

Metz, Christopher M.; Freiberg, Andrew A.

doi:10.1016/s0883-5403(98)90175-9

Cited by 31 publications

(16 citation statements)

References 5 publications

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“…Theatre cost and cost per bed day were taken from national studies; theatre cost varied according to the type of prosthesis. 25,26 In order to reflect the fact that the cost of a revision is higher than that of a primary THA, 27 we used a cost study of revision THAs. The cost of a one-stage revision was estimated to be 1.4 times higher than that of a primary THA (resulting in a cost of £7828) and the cost of a two-stage procedures 3.6 times higher (resulting in a cost of £20 421).…”

Section: Methodsmentioning

confidence: 99%

Lifetime cost effectiveness of different brands of prosthesis used for total hip arthroplasty

Pennington

Grieve

Meulen

2015

The Bone & Joint Journal

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There is little evidence on the cost effectiveness of different brands of hip prostheses. We compared lifetime cost effectiveness of frequently used brands within types of prosthesis including cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed) and hybrid (Exeter V40 Trilogy, Exeter V40 Trident, and CPT Trilogy). We used data from three linked English national databases to estimate the lifetime risk of revision, quality-adjusted life years (QALYs) and cost. For women with osteoarthritis aged 70 years, the Exeter V40 Elite Plus Ogee had the lowest risk of revision (5.9% revision risk, 9.0 QALYs) and the CPT Trilogy had the highest QALYs (10.9% revision risk, 9.3 QALYs). Compared with the Corail Pinnacle (9.3% revision risk, 9.22 QALYs), the most commonly used brand, and assuming a willingness-to-pay of £20,000 per QALY gain, the CPT Trilogy is most cost effective, with an incremental net monetary benefit of £876. Differences in cost effectiveness between the hybrid CPT Trilogy and Exeter V40 Trident and the cementless Corail Pinnacle and Taperloc Exceed were small, and a cautious interpretation is required, given the limitations of the available information. However, it is unlikely that cemented brands are among the most cost effective. Similar patterns of results were observed for men and other ages. The gain in quality of life after total hip arthroplasty, rather than the risk of revision, was the main driver of cost effectiveness. Cite this article: Bone Joint J 2015;97-B:762-70.

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Section: Methodsmentioning

confidence: 99%

Lifetime cost effectiveness of different brands of prosthesis used for total hip arthroplasty

Pennington

Grieve

Meulen

2015

The Bone & Joint Journal

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“…23 Unit costs of revisions are generally higher than for the initial surgery 24 ; here we multiplied the average total cost of a primary total hip replacement by a factor that differed according to the reason for revision (3.6 for two stage revisions and 1.4 for one stage revisions). 25 All unit costs were reported in British pounds (£1.00; $1.60; €1.20) according to 2010-11 prices.…”

Section: Costsmentioning

confidence: 99%

Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis

Pennington

Grieve

Sekhon

et al. 2013

BMJ

110

106

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Objective To compare the cost effectiveness of the three most commonly chosen types of prosthesis for total hip replacement.Design Lifetime cost effectiveness model with parameters estimated from individual patient data obtained from three large national databases. Setting English National Health Service.Participants Adults aged 55 to 84 undergoing primary total hip replacement for osteoarthritis.Interventions Total hip replacement using either cemented, cementless, or hybrid prostheses. Cost (£), quality of life (EQ-5D-3L, where 0 represents death and 1 perfect health), quality adjusted life years (QALYs), incremental cost effectiveness ratios, and the probability that each prosthesis type is the most cost effective at alternative thresholds of willingness to pay for a QALY gain. Main outcome measuresResults Lifetime costs were generally lowest with cemented prostheses, and postoperative quality of life and lifetime QALYs were highest with hybrid prostheses. For example, in women aged 70 mean costs were £6900 ($11 000; €8200) for cemented prostheses, £7800 for cementless prostheses, and £7500 for hybrid prostheses; mean postoperative EQ-5D scores were 0.78, 0.80, and 0.81, and the corresponding lifetime QALYs were 9.0, 9.2, and 9.3 years. The incremental cost per QALY for hybrid compared with cemented prostheses was £2500. If the threshold willingness to pay for a QALY gain exceeded £10 000, the probability that hybrid prostheses were most cost effective was about 70%. Hybrid prostheses have the highest probability of being the most cost effective in all subgroups, except in women aged 80, where cemented prostheses were most cost effective. ConclusionsCemented prostheses were the least costly type for total hip replacement, but for most patient groups hybrid prostheses were the most cost effective. Cementless prostheses did not provide sufficient improvement in health outcomes to justify their additional costs. IntroductionTotal hip replacement is one of the most common surgical procedures. In 2010 the global market for hip prostheses was estimated at $4.7b (£3.0b; €3.5b).1 A large number of different prosthesis designs have been developed and introduced on the market. For example, in England and Wales in 2010 at least 123 different brands of acetabular cups and 146 brands of femoral stems were used.2 These prosthesis brands are often grouped into cemented, cementless, and hybrid prostheses. Hybrid prostheses consist of cemented stems and cementless cups.Cementless prostheses, although the most expensive, have become the most common type of prosthesis used for total hip replacement in England, Wales, Italy, Australia, Canada, and the United States, with hybrid prostheses growing in popularity. [2][3][4][5][6] The increasing use of cementless components has contributed to a doubling of prosthesis costs between 1996 and 2006. 7 Although a recent study analysing data from the National Joint Registry for England and Wales, the largest orthopaedic registry in the world, suggested that cementless prosthese...

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“…Indeed, metal-on-polyethylene total hip arthroplasty is not as successful in younger patients when compared with the same procedure in older patients [1][2][3]. Conversely, the selection of a hip prosthesis in elderly and low-demand patients should be made after a careful cost-benefit analysis, as high-demand cementless components are expensive [12]. Metal-on-metal prostheses have low volumetric wear compared with that of metal-on-polyethylene implants [11] and their use is justified in young patients, in whom the durability of an implant is of paramount importance.…”

Section: Discussionmentioning

confidence: 99%

A comparative study on medium-term results of cementless acetabular components with metal-on-metal and metal-on-polyethylene articulations

Cozzolino

Mariconda

Costa

et al. 2002

J Orthopaed Traumatol

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The purpose of this study was to evaluate the medium-term clinical and radiological outcomes of two metal-backed acetabular cups with metal-on-metal and metal-on-polyethylene joint couples, in patients unselected for age. Seventy-five metal-on-polyethylene CLS expansion cups were implanted in 70 patients and 66 metal-on-metal Fitek cups were implanted in 65 patients. The average age at surgery in the two groups was 63 years (range, 25 to 72 years) and 58 years (range, 32 to 68 years), respectively. Data regarding 64 of 75 CLS cups (85%) and 58 of 66 Fitek cups (88%) were collected at a minimum 36-month and maximum 144-month follow-up. The Harris hip score showed excellent results in 86% of the CLS cups, good results in 7%, and fair results in 7%. No poor results were recorded. For metal-on-metal acetabular components, excellent results were recorded in 84% of the cups, good results in 8%, fair results in 5%, and poor results in 3%. Fifty-five patients with 57 of 64 CLS cups (89%) and 50 patients with 51 of 58 Fitek cups (88%) were fully satisfied with their prosthesis. No acetabular reconstructions were revised for aseptic loosening. No radiolucent lines greater than 2 mm were observed, either about CLS or Fitek cups, and low incidence of osteolysis and polyethylene wear was noted in metal-on-polyethylene articulations. Post-operative three-phase bone scanning was obtained in 51 patients and this examination did not show increased uptake in blood pool or bone phase indicating aseptic loosening of CLS and Fitek cups. In conclusion, we found similar rates of excellent and good results using two acetabular components with different bearing surfaces, in patients of unselected age. Therefore, the less expensive implant should be selected for total hip arthroplasty in elderly or low-demand patients.

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An international comparative study of total hip arthroplasty cost and practice patterns

Cited by 31 publications

References 5 publications

Lifetime cost effectiveness of different brands of prosthesis used for total hip arthroplasty

Lifetime cost effectiveness of different brands of prosthesis used for total hip arthroplasty

Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis

A comparative study on medium-term results of cementless acetabular components with metal-on-metal and metal-on-polyethylene articulations

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