Cost effectiveness of total hip arthroplasty in osteoarthritis

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.

Cost-effectiveness of surgical interventions for the management of osteoarthritis: a systematic review of the literature

“…The results obtained in this study were similar for both men and women [23]. The third study [40] compared five different techniques for THA from an NHS/PSS perspective and concluded that it is difficult to make a choice between techniques based on cost-effectiveness grounds alone. The fourth study assessed the cost-effectiveness of three types of prosthesis for hip replacement (cemented, cementless and hybrid) in adults aged between 55 and 84 years.…”

“…UKA was therefore considered superior to TKA.- Analysis determined that the model is sensitive to clinical effectiveness, and that a marginal reduction in the clinical performance of UKA would lead to TKA being the more cost-effective solution.- The acceptability curve shows that the probability that the ICER falls below the threshold of: €10,000 (77.1%) , €25,000 (65.1%) and €50,000 (60.5%).UKA yields clear advantages in terms of costs and marginal advantages in terms of health effects, in comparison with TKA.7221.Pennington et al, [23]Different brands within types of hips prosthesis (cemented, cementless and hybrid)For women with OA 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 (the most commonly used brand), 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.The hybrid CPT-Trilogy was the most cost effective brand but differences with the hybrid Exeter V40-Trident and the cementless Corail-Pinnacle and Taperloc-Exceed were small. Our study shows the importance of linking PROMs with data on rates of revision after THA but given the extended period of recovery after a THA, collecting further PROMs and QoL beyond the first six months after THA is an important next step which would strengthen future economic evaluations of brands of hip prostheses.5722.Pulikottil-Jacob et al, [40]- Metal head (cemented stem) on cemented polyethy-lene cup, CeMoP- Metal head (cement-less stem) on cement-less hydroxyapetite coated metal cup (polyethylene liner), CeLMoP- Ceramic head (cementless stem) on cementless hydroxyl-apetite coated metal cup (ceramic liner), CeLCoC- Hybrid metal head (cemented stem) on cementless hydroxyl-apetite coated metal cup (polyethylene liner), HyMoP- Ceramic head (cemented stem) on cemented polyethy-lene cup, CeCoP- base-case analysis : At a WTP £20,000 per QALY, a cemented prosthesis with metal-onpolyethylene or ceramic-on-polyethylene bearings had the greatest probability of being cost-effective for all groups of age and gender over a lifetime.- The differences in QALYs between categories were extremely small and differences in mean costs were borderline, between only £2550 and £3000 over a lifetime for all comparisons, irrespective of age or gender.- There are large uncertainties, particularly regarding the costs of prostheses and the estimates of lifetime QOL.On the basis of such small differences and such considerable uncertainties, it is difficult to make a comparison between the cost-effectiveness of different types of prosthesis. Until better data dealing with costs and outcomes become available, it is difficult to justify the recommendation of one type of device over another on considerations of cost effectiveness alone.…”

Handling the procurement of prostheses for total hip replacement: description of an original value based approach and application to a real-life dataset reported in the UK

“…After selecting a total of 51 eligible papers from our literature analysis (date of the last PubMed search: 15 June 2017), we identified the studies by Pennington et al 9 and Pulikottil-Jacob et al 10 as potentially suitable data sources for our analysis. Of these two studies, we selected the article by Pennington et al 9 because this paper evaluated a larger number of device brands than the study by Pulikottil-Jacob et al .…”

“…Of these two studies, we selected the article by Pennington et al 9 because this paper evaluated a larger number of device brands than the study by Pulikottil-Jacob et al . 10 In fact, there were nine brands versus five brands, respectively, in these studies 9 10 In more detail, the study by Pennington et al 9 used a Markov model to evaluate the cost–utility profile, expressed in terms of NMB, of the following nine brands of THA prostheses: Exeter V40/Contemp, Exeter V40/Duration, Exeter V40/Elite Plus Ogee (cemented prostheses), Corail/Pinnacle, Accolate/Trident, Taperloc/Exceed (cementless prostheses), Exeter V40/Trident, Exeter V40/Trilogy and CPT/Trilogy (hybrid prostheses). The horizon was lifetime, the yearly discount rate was 3.5%, and the willingness-to-pay threshold was set at £20 000 per QALY.…”

Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales

“…This limits the implications of their findings as pooling brands and configurations (when comparing procedures) may mask important differences between brand, configuration and procedure. However, Pulikottil-Jacob et al took this a step further by examining different types of hip replacement fixation and bearing, and found that available evidence does not support recommending a particular device on cost effectiveness grounds alone, although the authors did not examine PROMs or complication data [ 48 ].…”