Use of Cost-Effectiveness Analysis to Evaluate New Technologies in Orthopaedics: The Case of Alternative Bearing Surfaces in Total Hip Arthroplasty

Bozic, Kevin J.; Morshed, Saam; Silverstein, Marc D.; Rubash, Harry E.; Kahn, James G.

doi:10.2106/jbjs.e.00614

Cited by 60 publications

(80 citation statements)

References 50 publications

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“…However, with the increasing utilization of TJR [6], the age-related differences in the future incidence of TJR remain unexplored. This is of particular concern because more costly premium hard-on-hard bearings are intended for the younger patient population [1], which could have substantial impact on future healthcare resources. We therefore evaluated the historical changes in demand for primary and revision TJR in the younger and older patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…''Premium'' implant technologies, such as hard-on-hard bearings and hip resurfacing, have been introduced to address the increased activity and need for improved implant longevity in younger patients. However, these bearings are associated with higher costs and questions regarding their cost-effectiveness for the elderly patient population have been raised [1]. Previous projections by our group focused on estimating the total nationwide demand for primary and revision TJR [6], and not quantified the relative future size of the young TJR population in the United States that may benefit from premium implants.…”

Section: Introductionmentioning

confidence: 99%

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Future Young Patient Demand for Primary and Revision Joint Replacement: National Projections from 2010 to 2030

Kurtz

Lau

Ong

et al. 2009

Clinical Orthopaedics &Amp; Related Research

1,294

828

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Previous projections of total joint replacement (TJR) volume have not quantified demand for TJR surgery in young patients (\ 65 years old). We developed projections for demand of TJR for the young patient population in the United States. The Nationwide Inpatient Sample was used to identify primary and revision TJRs between 1993 and 2006, as a function of age, gender, race, and census region. Surgery prevalence was modeled using Poisson regression, allowing for different rates for each population subgroup over time. If the historical growth trajectory of joint replacement surgeries continues, demand for primary THA and TKA among patients less than 65 years old was projected to exceed 50% of THA and TKA patients of all ages by 2011 and 2016, respectively. Patients less than 65 years old were projected to exceed 50% of the revision

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Future Young Patient Demand for Primary and Revision Joint Replacement: National Projections from 2010 to 2030

Kurtz

Lau

Ong

et al. 2009

Clinical Orthopaedics &Amp; Related Research

1,294

828

View full text Add to dashboard Cite

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“…Implant costs vary widely among countries and individual healthcare facilities; however, the relationship is consistent with the price of CoC being higher than the price of CoPxl, which is higher than the price of MoPxl [7]. The economic impact of these decisions on the individual patient, provider, and hospital, up to the level of payers and societies, will be important to consider moving forward.…”

Section: Discussionmentioning

confidence: 89%

“…This cohort is challenging because patients are presumed to have a higher activity level and increased life expectancy-both primary risk factors for mechanical failure of the prosthesis [37]. Therefore, use of modern materials with improved wear characteristics such as ceramics, crosslinked polyethylenes, and metal-onmetal (MoM) articulations have become popular options for younger, more active patients undergoing THA [7].…”

Section: Introductionmentioning

confidence: 99%

There Are No Differences in Short- to Mid-term Survivorship Among Total Hip-bearing Surface Options: A Network Meta-analysis

Wyles

Jiménez-Almonte

Murad

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Total hip arthroplasty (THA) is increasingly being performed in patients with long life expectancies and active lifestyles. Newer implant bearing surfaces, with superior wear characteristics, often are used in this cohort with the goal of improving longevity of the prosthesis, but comparisons across the numerous available bearing surfaces are limited, so the surgeon and patient may have difficulty deciding which implants to use. Questions/purposes The purpose of this study was to answer the following question: Is there a short-to mid-term survivorship difference between common THA bearings used in patients younger than age 65 years? Methods We conducted a systematic review to identify randomized clinical trials (RCTs) published after 2000 that reported survivorship of ceramic-on-ceramic (CoC), ceramic-on-highly crosslinked polyethylene (CoPxl), or metalon-highly crosslinked polyethylene (MoPxl) bearings. To qualify for our review, RCTs had to have a minimum 2-year followup and study patients were required to have an average age younger than 65 years. Direct-comparison meta-analysis and network meta-analysis were performed to combine direct and indirect evidence. IN, USA). One of the authors certifies that he (RTT), or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from MAKO Surgical Corp, USD 10,000 to USD 100,000 from DePuy Orthopaedics, Inc, and less than USD 10,000 from Wright Medical Technology, Inc. One of the authors certifies that he (RJS), or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Biomet Inc. 123Clin Orthop Relat Res (2015) 473:2031-2041 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® the three implant types, demonstrating the following probabilities of most effective implant with 95% credible intervals (CrI): CoC = 64.6% (0%-100%); CoPxl = 24.9% (0%-100%); and MoPxl = 9.9% (0%-100%). The CrIs ranged from 0% to 100% for all three bearing surfaces. Direct-comparison meta-analysis allowed for pooling of five RCTs, including 779 THAs, whereas network metaanalysis (before post hoc analysis) enabled pooling of 18 RCTs, including 2599 THAs. Conclusions Current published evidence does not support survivorship differences among commonly used bearing surfaces in patients younger than age 65 years undergoing THA at short-to mid-term followup. Long-term RCT data will be needed to determine if a survivorship benefit is realized in younger, more active patients over time. Level of Evidence Level I, therapeutic study.

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“…23,25 In a few studies, the cost of the device itself was deemed to be a primary cost driver. 8,10,26 However, device prices generally change over time, due to arrival of new products on the market, iterative developments, or ways in which they are procured in different health systems, and the short time horizons used in the majority of studies would not reflect price reductions over time. This differs from the case of drugs, where prices rarely change until the product loses patent protection.…”

Section: Health Outcomes and Costsmentioning

confidence: 99%

Socioeconomic value of orthopedic devices: evidence and methodological challenges

Sorenson¹,

Drummond²

2012

ORR

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Abstract:With continued technological advances in orthopedic devices and increasingly limited health care resources, greater attention will be placed on substantiating the socioeconomic value of these devices. Therefore, this study focused on a systematic review of available economic evaluations of selected orthopedic devices (n = 33 studies) to assess their impact on different clinical and economic outcomes. The existing evidence suggests that they have important benefits to patients, including reduced risk of fractures, increased mobility and functioning, and enhanced quality of life, and do so cost effectively or with cost savings. However, we have identified several methodological obstacles to sufficient ascertainment of value, such as a lack of robust information on health economic outcomes and long-term evidence. We also identify areas where additional research is needed to assess more fully the value of orthopedic devices.

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Use of Cost-Effectiveness Analysis to Evaluate New Technologies in Orthopaedics: The Case of Alternative Bearing Surfaces in Total Hip Arthroplasty

Cited by 60 publications

References 50 publications

Future Young Patient Demand for Primary and Revision Joint Replacement: National Projections from 2010 to 2030

Future Young Patient Demand for Primary and Revision Joint Replacement: National Projections from 2010 to 2030

There Are No Differences in Short- to Mid-term Survivorship Among Total Hip-bearing Surface Options: A Network Meta-analysis

Socioeconomic value of orthopedic devices: evidence and methodological challenges

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