Is Hip Arthroscopy Cost-effective for Femoroacetabular Impingement?

Abstract

Background The impact of hip arthroscopy on healthrelated quality of life (HRQoL) among younger patients with symptomatic femoroacetabular impingement (FAI) is unknown, but with increasing recognition of the condition there is likely to be increasing demand for arthroscopy. Questions/purposes We describe an approach to determine the incremental cost-effectiveness of hip arthroscopy compared with observation in patients with FAI; we also identified variables that influence its cost-effectiveness. Patients and MethodsWe constructed a Markov model including possible health states for 36-year-old patients with FAI using decision analysis software and compared two strategies: (1) observation and (2) hip arthroscopy, followed by THA with disease progression. We estimated the ratio of the incremental cost to the incremental benefit (reflected by HRQoL) of both strategies. We identified studies reporting Harris hip scores and complications after arthroscopy to estimate health state preferences and their probabilities. We performed sensitivity analyses on 30 input variables over a plausible range of estimates to determine

Surgical Approaches for Cam Femoroacetabular Impingement: The Use of Multicriteria Decision Analysis

“…Despite this, the costs that we used to study HA are very similar to those used previously to calculate the cost-effectiveness of this particular procedure in the west coast of the United States [33]. For this reason, we believe that our conclusions are valid.…”

Diagnosis of Periprosthetic Joint Infection in Medicare Patients: Multicriteria Decision Analysis

“…Several authors have discussed the use and application of the analytic hierarchy process in health and medical decision making. Although other methods of cost-efficiency/cost-effectiveness analysis are available and have been used in the setting of the orthopaedic research [26,29], we believed that benefits, opportunities, costs, and risks analysis using analytic hierarchy process was more appropriate for the inclusion of qualitative measurements, such as in our study. Furthermore, we expect that our paper will serve to introduce a formalized and accessible method of decision making to the orthopaedic community.…”

Early Experience With a Comprehensive Hip Preservation Service Intended to Improve Clinical Care, Education, and Academic Productivity

“…Although it is difficult to directly measure the educational benefit of the HPS to all participants, we found improvement in orthopaedic resident performance on the OITE and the lower extremity domain of ABOS Part I examination. Given the current rapid expansion of hip preservation surgery, particular emphasis on improving educational curricula related to hip preservation would seem to be prudent at this time [33]. A key component of this has been creation of a multidisciplinary hip preservation conference.…”

“…Although open hip procedures, such as surgical dislocation [10,13,29,34] for femoroacetabular impingement (FAI) and periacetabular osteotomy (PAO) [8,23,28,35] for acetabular dysplasia, reportedly improve pain and function [8,13], arthroscopic treatment has become a reasonable alternative to open hip approaches [7,11,16,17,20,24,30,32,33]. Arthroscopic treatment of hip disorders, such as labral injury and FAI, has increased dramatically over the past 5 years, and results indicating improvement in pain and function, as measured predominately with the Harris hip score (HHS), have been reported [7,11,16,20,24,30].…”