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

Abstract

Background Currently, three surgical approaches are available for the treatment of cam femoroacetabular impingement (FAI), namely surgical hip dislocation (SHD), hip arthroscopy (HA), and the miniopen anterior approach of the hip (MO). Although previous systematic reviews have compared these different approaches, an overall assessment of their performance is not available. Questions/purposes We therefore executed a multidimensional structured comparison considering the benefits, opportunities, costs, and risk (BOCR) of the different approaches using multicriteria decision analysis (MCDA). Methods A MCDA using analytic hierarchical process (AHP) was conducted to compare SHD, HA, and MO in terms of BOCR on the basis of available evidence, institutional experience, costs, and our understanding of pathophysiology of FAI. A preclinical decision-making model was created for cam FAI to establish the surgical approach that better accomplishes our objectives regarding the surgical treatment. A total score of an alternative's utility and sensitivity analysis was established using commercially available AHP software. Results The AHP model based on BOCR showed that MO is the best surgical approach for cam FAI (normalized score: 0.38) followed by HA (normalized score: 0.36) and SHD (normalized score: 0.25). The sensitivity analysis showed that HA would turn into the best alternative if the variable risks account for more than 61.8% of the priority during decision-making. In any other decision-making scenario, MO remains as the best alternative. Conclusions Using a recognized method for decisionmaking, this study provides supportive data for the use of MO approach as our preferred surgical approach for cam FAI. The latter is predominantly derived from the lower cost of this approach. Our data may be considered a proxy performance measurement for surgical approaches in cam FAI. Level of Evidence Level II, economic and decision analyses. See the Guidelines for Authors for a complete description of levels of evidence.

Applying the Analytic Hierarchy Process in healthcare research: A systematic literature review and evaluation of reporting

“…Some authors defined the criteria according to standards or established guidelines [ 25 , 50 , 52 , 59 , 80 , 84 , 92 , 93 , 104 – 108 ] or even from previous study results [ 25 , 47 , 62 , 68 , 69 , 71 , 72 , 81 ]. Still other authors relied on their own expertise [ 64 , 73 , 107 , 109 , 110 ].…”

“…The sample sizes varied between one author who judged the AHP for himself [ 73 , 107 – 109 ] to 1,283 participants [ 55 ]. In total, 50 of the 69 articles reported the number of participants in their AHP studies.…”

Healthcare decision‐making applications using multicriteria decision analysis: A scoping review

“…Twenty‐five case studies used an MCDA process to assess the value of different treatment options. These options could be for surgery alternatives (Diaz‐Ledezma and Parvizi, ; Hummel, Boomkamp, Steuten, Verkerke, & Ijzerman, ), drug availability (Mohl & Ohrbach, ; Wen, Zhang, & Yang, ), the implementation of health programmes (Baltussen et al, ), and therapies (Tony, Goetghebeur, et al, ), or for assessing the value of medical technologies used in treatments (Angelis & Kanavos, ).…”

“…Thirteen papers were characterized as hospital‐level studies, among which nine were performed for preventive interventions. In these nine studies, MCDA was used to evaluate the selection process for new medical devices (Lu, Lin, & Tzeng, ; Ivlev, Vacek, & Kneppo, ; Nobre, Trotta, & Gomes, ; Ahmadi, Nilashi, & Ibrahim, ), to assess quality care in hospitals (Akdag, Kalayci, Karagoz, Zulfikar, & Giz, ; Wang, Chang, Liu, & Chen, ; Longaray et al, ), to compare surgical approaches (Diaz‐Ledezma and Parvizi, ), to develop a process for site selection (Vahidnia et al, ), to set a new fee schedule (Hung et al, ), and to support HTA decision‐making processes (Ritrovato, Faggiano, Tedesco, & Derrico, ). One study (Koch & Rowell, ) was concerned with treatment interventions and aimed at assessing an organ transplant allocation process.…”

“…In contrast, when the objective was to assess quality of care (Akdag et al, ; Wang et al, ), the criteria (17 in the first study and 46 in the second one) were various indicators of quality care such as responsiveness and empathy or hospital characteristics such as capacity, modernity, and security. When the objective was to compare surgical approaches (Diaz‐Ledezma and Parvizi, ), the criteria were benefits, opportunities, costs, and risks.…”