The impact of preoperative patient characteristics on the cost-effectiveness of total hip replacement: a cohort study

Abstract

BackgroundTo facilitate the discussion on the increasing number of total hip replacements (THR) and their effectiveness, we apply a joint evaluation of hospital case costs and health outcomes at the patient level to enable comparative effectiveness research (CER) based on the preoperative health state.MethodsIn 2012, 292 patients from a German orthopedic hospital participated in health state evaluation before and 6 months after THR, where health-related quality of life (HRQoL) and disease specific pain and dysfunction were analyzed using EQ-5D and WOMAC scores. Costs were measured with a patient-based DRG costing scheme in a prospective observation of a cohort. Costs per quality-adjusted life year (QALY) were calculated based on the preoperative WOMAC score, as preoperative health states were found to be the best predictors of QALY gains in multivariate linear regressions.ResultsMean inpatient costs of THR were 6,310 Euros for primary replacement and 7,730 Euros for inpatient lifetime costs including revisions. QALYs gained using the U.K. population preference-weighted index were 5.95. Lifetime costs per QALY were 1,300 Euros.ConclusionsThe WOMAC score and the EQ-5D score before operation were the most important predictors of QALY gains. The poorer the WOMAC score or the EQ-5D score before operation, the higher the patient benefit. Costs per QALY were far below common thresholds in all preoperative utility score groups and with all underlying calculation methodologies.

Cost-effectiveness of timely versus delayed primary total hip replacement in Germany: A social health insurance perspective

“…Vogl and colleagues found that THR was associated with positive undiscounted incremental costs of €7,730 relative to medical therapy, and reported higher costs among patients with more severe disease. 90 The undiscounted incremental costs of timely THR in a 65 year old in our analysis were instead €2024 in females, and €3,524 in males. The difference with our results is due to Vogl’s assumption that the non-surgical costs in the THR arm were equal to those of the medical arm, whereas we accounted for higher non-surgical healthcare costs in the medical therapy arm than under timely THR, especially after disease progression.…”

“…In contrast, we found larger QALY gains for timely than among delayed therapy despite the more severe status of patients at the time of delayed THR and allowance in our analysis for larger pre to post-operative health gains of patients with more severe disease. 48 The reason for the different results between the two studies is that delayed THR arm in our study measured the expected QALY gains at the time the decision between timely, delayed or no surgery is made, whereas the results by disease severity reported by Vogl 90 are calculated at the time patients are operated and therefore, unlike our results, miss the loss in utility during any delay of treatment experienced by the more severe patients.…”

“…The only relevant existing study in Germany used long-term costs and benefit extrapolations from 6-month HRQoL outcomes and hospital resource utilisation by a group of 261 mostly OA patients of mean age 68 following primary or revision (n=10) THR. 90 It found that THR resulted in additional undiscounted QALYs of 5.95 relative to medical therapy and that more severe patients ( i.e . low WOMAC scores) had larger QALY gains than patients with high WOMAC scores.…”

Lung transplantation in the spotlight: Reasons for high-cost procedures

“…15 We recently used this approach to examine the cost structure in hip replacement surgery. 31 The InEK scheme differentiates by cost centers and cost categories (investment costs excluded). Each combination of a cost center and cost category is allocated to an activity-based cost driver; for example, costs of the physicians (cost category) on ICU (cost center) are attributed to individual LTX patients according to their treatment interval at the ICU (activity-based cost driver).…”

An Experience-Based Value Set for the EQ-5D-5L in Germany

“…In this version, VAS values were estimated at the population level in previous studies [12,13], but EBVSs have only been developed for Germany, Sweden, and China [10,14,15]. These EVBSs have also been used and tested in a number of chronic diseases [16][17][18][19][20][21] and in elective surgery [22,23]. Meanwhile, a more differentiated version, the EQ-5D-5L, has been developed, covering five problem levels and a total of 3125 health states [24].…”