Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation

Clarke, Aileen; Pulikottil-Jacob, Ruth; Grove, Amy; Freeman, Karoline; Mistry, Hema; Tsertsvadze, Alexander; Connock, Martin; Court, Rachel; Kandala, Ngianga‐Bakwin; Costa, Matthew L.; Suri, Gaurav; Metcalfe, David; Crowther, Michael J.; Morrow, Sarah; Johnson, Samantha; Sutcliffe, Paul

doi:10.3310/hta19100

Cited by 36 publications

(31 citation statements)

References 406 publications

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“…In der Vielfalt der im Markt erhältlichen Gleitpaarungen sind durchaus deutlich höhere Kostenunterschiede als in unserer Studie möglich. Eine Erhebung der tatsächlichen Sachkosten im National Health System zeigte einen Kostenunterschied von bis zu 2312 GBP (etwa 3100 €) zwischen der günstigsten Fixierungstechnik (zementierter Schaft, Metallkopf, zementierte Polyethylen-Hüftgelenkpfan-ne: 1557 GBP, etwa 2100 €,) und der teuersten Technik (zementfreie Schaft, Keramikkopf, zementfreie Keramikpfanne: 3869 GBP, etwa 5250 €) auf [3].…”

Section: Discussionunclassified

Teilzementierte und unzementierte Hüftendoprothetik

et al. 2015

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Section: Discussionunclassified

Teilzementierte und unzementierte Hüftendoprothetik

et al. 2015

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“…At an average cost of about £6000, primary THA costs the NHS approximately £64 million per annum. 3 Assuming an estimated rate of revision of about 5% over the lifetime of 80 000 recipients and an average cost of revision of about £17 000, 3 failure adds about another £68 million over subsequent years. The UK National Institute for Health and Care Excellence (NICE) 4 has issued guidance (TA2 and TA44) which suggests that clinicians and manufacturers should aim to achieve a benchmark revision rate of < 10% over ten years.…”

mentioning

confidence: 99%

Cost effectiveness of total hip arthroplasty in osteoarthritis

Pulikottil-Jacob

Connock

Kandala

et al. 2015

The Bone & Joint Journal

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Many different designs of total hip arthroplasty (THA) with varying performance and cost are available. The identification of those which are the most cost-effective could allow significant cost-savings. We used an established Markov model to examine the cost effectiveness of five frequently used categories of THA which differed according to bearing surface and mode of fixation, using data from the National Joint Registry for England and Wales. Kaplan-Meier analyses of rates of revision for men and women were modelled with parametric distributions. Costs of devices were provided by the NHS Supply Chain and associated costs were taken from existing studies. Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and the probability of a device being cost effective at a willingness to pay £20 000/QALY were included in the models. The differences in QALYs between different categories of implant were extremely small (< 0.0039 QALYs for men or women over the patient's lifetime) and differences in cost were also marginal (£2500 to £3000 in the same time period). As a result, the probability of any particular device being the most cost effective was very sensitive to small, plausible changes in quality of life estimates and cost. Our results suggest that available evidence does not support recommending a particular device on cost effectiveness grounds alone. We would recommend that the choice of prosthesis should be determined by the rate of revision, local costs and the preferences of the surgeon and patient.

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“…A total hip construct consists of a femoral component that articulates with an acetabular component (see Appendix Table A1 for a classification of prostheses). THR is an MD with a relatively well‐supported clinical effectiveness evidence base that includes RCTs as well as data from numerous large national registries, and is well‐suited to use as an illustrative application of generalized evidence synthesis approaches that combine RCT and OSs in a meta‐analysis (Clarke et al ).…”

Section: Methodsmentioning

confidence: 99%

“…We identified the evidence base for this study using four previously published systematic reviews of THRs undertaken by the HTA Programme in UK (Clarke et al , , Faulkner et al , , Fitzpatrick et al ,, Vale et al , ) and four additional systematic reviews cited in reports (Tsertsvadze et al , , Clement et al ,, Pakvis et al , , Voigt and Mosier, ).…”

Section: Methodsmentioning

confidence: 99%

A bias‐adjusted evidence synthesis of RCT and observational data: the case of total hip replacement

Iglesias

Arvandi²,

Ciani

et al. 2017

Health Economics

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Evaluation of clinical effectiveness of medical devices differs in some aspects from the evaluation of pharmaceuticals. One of the main challenges identified is lack of robust evidence and a will to make use of experimental and observational studies (OSs) in quantitative evidence synthesis accounting for internal and external biases. Using a case study of total hip replacement to compare the risk of revision of cemented and uncemented implant fixation modalities, we pooled treatment effect estimates from OS and RCTs, and simplified existing methods for bias-adjusted evidence synthesis to enhance practical application.We performed an elicitation exercise using methodological and clinical experts to determine the strength of beliefs about the magnitude of internal and external bias affecting estimates of treatment effect. We incorporated the bias-adjusted treatment effects into a generalized evidence synthesis, calculating both frequentist and Bayesian statistical models. We estimated relative risks as summary effect estimates with 95% confidence/credibility intervals to capture uncertainty.When we compared alternative approaches to synthesizing evidence, we found that the pooled effect size strongly depended on the inclusion of observational data as well as on the use bias-adjusted estimates. We demonstrated the feasibility of using observational studies in meta-analyses to complement RCTs and incorporate evidence from a wider spectrum of clinically relevant studies and healthcare settings. To ensure internal validity, OS data require sufficient correction for confounding and selection bias, either through study design and primary analysis, or by applying post-hoc bias adjustments to the results.

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Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation

Abstract: The National Institute for Health Research Health Technology Assessment programme.

Cited by 36 publications

References 406 publications

Teilzementierte und unzementierte Hüftendoprothetik

Teilzementierte und unzementierte Hüftendoprothetik

Cost effectiveness of total hip arthroplasty in osteoarthritis

A bias‐adjusted evidence synthesis of RCT and observational data: the case of total hip replacement

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