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

Abstract

ObjectivesIn most European countries, innovative medical devices are not managed according to cost–utility methods, the reason being that national agencies do not generally evaluate these products. The objective of our study was to investigate the cost-utility profile of prostheses for hip replacement and to calculate a value-based score to be used in the process of procurement and tendering for these devices.MethodsThe first phase of our study was aimed at retrieving the studies reporting the values of QALYs, direct cost, and net monetary benefit (NMB) from patients undergoing total hip arthroplasty (THA) with different brands of hip prosthesis. The second phase was aimed at calculating, on the basis of the results of cost–utility analysis, a tender score for each device (defined according to standard tendering equations and adapted to a 0–100 scale). This allowed us to determine the ranking of each device in the simulated tender.ResultsWe identified a single study as the source of information for our analysis. Nine device brands (cemented, cementless, or hybrid) were evaluated. The cemented prosthesis Exeter V40/Elite Plus Ogee, the cementless device Taperloc/Exceed, and the hybrid device Exeter V40/Trident had the highest NMB (£152 877, £156 356, and £156 210, respectively) and the best value-based tender score.ConclusionsThe incorporation of value-based criteria in the procurement process can contribute to optimising the value for money for THA devices. According to the approach described herein, the acquisition of these devices does not necessarily converge on the product with the lowest cost; in fact, more costly devices should be preferred when their increased cost is offset by the monetary value of the increased clinical benefit.

Value-based procurement of prostheses for total knee replacement

“…One criterion for selecting the published study to be used as data source for our analysis was that the selected study had to report a Markov model suitable for calculating the QALYs per patient. As in our previous analysis, 1 in the present study we planned to determine the value of QALYs per patient by directly using the values of QALY reported in the selected paper or by recalculating these values using the computer program (if publicly available) employed in the selected study or, alternatively, by rewriting the Markov model using the language of a commercial software (Treeage Pro version 11, Treeage Inc, Williamstown, Massachusetts) thus recalculating these values. QALYs are typically applied based on a clinical scenario covering several years; accordingly, our simulation model employed a time horizon of 20 years.…”

“…However, an original method has recently been proposed in the field of total hip arthroplasty to apply the principles of value-based procurement. 1 …”

Cost-effectiveness analyses comparing cemented, cementless, hybrid and reverse hybrid fixation in total hip arthroplasty: a systematic overview and critical appraisal of the current evidence

“…In addition to the 11 suitable studies identified with our search, one additional study was identified through backward reference searching of those studies [44]. Therefore, a total of 12 studies were included in this systematic review [40,[42][43][44][45][46][47][48][49][50][51][52].…”

“…hybrid fixation; stratified for multiple specific implant combinations (Continued ) compared cementless and hybrid fixation [47], three studies only compared cemented and cementless fixation [40,46,52], seven studies compared cemented, cementless and hybrid fixation [42][43][44][45][48][49][50], and in one study the cemented, cementless, hybrid and reverse hybrid fixation were compared [51]. Furthermore, varying subgroup-analyses, outcomes and time horizons have been studied along the included studies.…”

Pay less and spend more—the real value in healthcare procurement

“…VBP seems a feasible approach also for orthopaedic surgery, in terms of secondary prevention strategies of hip fracture (where assessment of bone health and metabolism is effective for decreasing the risk of morbidity and mortality after trauma) (37) and prosthesis supply for hip and knee arthroplasty, where the best prostheses were not the cheapest, but those providing the best clinical and economic benefits on the long term (38,39). Elective orthopaedic surgery represents a pragmatic example of the holistic benefits achievable by a valuable medical intervention, for which the main goal is not saving patients from acute or life-threatening disease, but re-establishing a certain degree of autonomy from loss of function (and possibly improving quality of life on the long-term).…”