Metal on metal hip resurfacing arthroplasty

Abstract

This paper explores the cost utility of metal-on-metal hip resurfacing arthroplasty (MOM) as an alternative intervention to total hip replacement or 'watchful waiting' for patients with advanced hip disease. Early implant failure among younger and more active elderly patients can mean that the use of total hip replacement (THR) is delayed, with patients managed through 'watchful waiting', a combination of pain control and other non-surgical interventions. Information on costs is combined with evidence on effectiveness from a systematic review in a Markov model in order to estimate the incremental cost per quality adjusted life year (QALY) of MOM relative to THR and 'watchful waiting'.

Update on hip and knee arthroplasty: Current state of evidence

“…Proponents suggest that the procedure will restore normal anatomy, maximize proprioception, minimize dislocation rates, and will be amenable to future revision/ conversion to a THA system should it wear or fail in the future. Recent reports suggest excellent clinical results at short-term followup; however, long-term data are not available (34,(37)(38)(39)(40)(41)(42).…”

Socioeconomic value of orthopedic devices: evidence and methodological challenges

“…Such improvements resulted in an average gain in QALYs of 2.01 (−0.02 to 6.88). 17,[19][20][21][22][23] Similar to estimates of therapeutic benefit, there was significant variability in cost estimates, depending on the technology under review, comparator(s) used, patient population, study time horizon, and cost methodology used. However, in the case of hip protectors, use almost always resulted in cost-savings ($68-$230 per person).…”

“…For hip protectors, these included baseline incidence of fractures, cost of protectors, and utility values, [9][10][11][12][13]24 while the cost-effectiveness ratio was most sensitive to estimated revision rates, implant costs, utility values, and patient characteristics, namely age and gender, in studies of hip implants. 22,[29][30][31] In those evaluations assessing other devices (eg, ankle and knee implants), the durability of the implant and the estimated utility values were most influential on cost-effectiveness. 20,21,32,33 However, no sensitivity analysis was undertaken in more than one third of the total studies, which is not in line with current methodological standards for economic evaluation.…”

“…Studies defined high-risk differently, but commonly used indicators including greater baseline incidence of fracture and postoperative relative risk of fracture, as well as prior lack of success or response to medical therapy. 8,10,[21][22][23] In some cases, high-risk related to the age and gender of patients, where cost-effectiveness was greatest in younger and female patient populations. 11,12,16,19,23,34 For example, given that women are more at risk for hip fracture than men and become so at an earlier age, the use of hip protectors was determined to be of most benefit if initiated earlier (ie, 75-80 years) in women and later in men (ie, 85 years).…”

“…10,14,18,25,31,[35][36][37] The other most frequently mentioned challenges included uncertainty around the data parameters used and the concern about the representativeness of the patient population or study setting, 9,12,14,22,24,30,32 which would impact the generalizability of the findings. In relation to the issue around data uncertainty, several researchers mentioned the fact that some of the data needed for the analyses were either not available or were of too poor quality to use with any confidence.…”