NDLI: Cost effectiveness of total hip arthroplasty in osteoarthritis: comparison of devices with differing bearing surfaces and modes of fixation.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Pulikottil-Jacob, R. Connock, M. Kandala, N-B Mistry, H. Grove, A. Freeman, K. Costa, M. Sutcliffe, P. Clarke, A.
Description	Country affiliation: United kingdom Author Affiliation: Pulikottil-Jacob R ( University of Warwick, Coventry CV4 7AL, UK.); Connock M ( University of Warwick, Coventry CV4 7AL, UK.); Kandala NB ( University of Warwick, Coventry CV4 7AL, UK.); Mistry H ( University of Warwick, Coventry CV4 7AL, UK.); Grove A ( University of Warwick, Coventry CV4 7AL, UK.); Freeman K ( University of Warwick, Coventry CV4 7AL, UK.); Costa M ( University of Warwick, Coventry CV4 7AL, UK.); Sutcliffe P ( University of Warwick, Coventry CV4 7AL, UK.); Clarke A ( University of Warwick, Coventry CV4 7AL, UK.)
Abstract	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.
File Format	HTM / HTML
ISSN	20494394
Issue Number	4
Volume Number	97-B
e-ISSN	20494408
Journal	Bone & Joint Journal
Language	English
Publisher	British Editorial Society of Bone & Joint Surgery
Publisher Date	2015-04-01
Publisher Place	Great Britain (UK)
Access Restriction	Subscribed
Subject Keyword	Discipline Orthopedics Discipline General Surgery Arthroplasty, Replacement, Hip Economics Hip Prosthesis Osteoarthritis, Hip Surgery Registries Aged Aged, 80 And Over Instrumentation Bone Cements Cementation Cost-benefit Analysis Female Humans Male Markov Chains Middle Aged Quality-adjusted Life Years Comparative Study Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery Sports Science

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