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Do the potential benefits of metal-on-metal hip resurfacing justify the increased cost and risk of complications?

Bozic KJ, Pui CM, Ludeman MJ, Vail TP, Silverstein MD - Clin. Orthop. Relat. Res. (2010)

Bottom Line: However, the cost effectiveness of MoM HRA compared with THA is unclear.We performed sensitivity analyses to evaluate the impact of patient characteristics, clinical outcome probabilities, quality of life and costs on the discounted incremental costs, incremental clinical effectiveness, and the incremental cost-effectiveness ratio (ICER) of HRA compared to THA.Further research on the comparative effectiveness of MoM HRA versus THA should include assessments of the quality of life and resource use in addition to the clinical outcomes associated with both procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus, MU 320W, San Francisco, CA 94143-0728, USA. evin.bozic@ucsf.edu

ABSTRACT

Background: Metal-on-metal hip resurfacing arthroplasty (MoM HRA) may offer potential advantages over total hip arthroplasty (THA) for certain patients with advanced osteoarthritis of the hip. However, the cost effectiveness of MoM HRA compared with THA is unclear.

Questions/purposes: The purpose of this study was to compare the clinical effectiveness and cost-effectiveness of MoM HRA to THA.

Methods: A Markov decision model was constructed to compare the quality-adjusted life-years (QALYs) and costs associated with HRA versus THA from the healthcare system perspective over a 30-year time horizon. We performed sensitivity analyses to evaluate the impact of patient characteristics, clinical outcome probabilities, quality of life and costs on the discounted incremental costs, incremental clinical effectiveness, and the incremental cost-effectiveness ratio (ICER) of HRA compared to THA.

Results: MoM HRA was associated with modest improvements in QALYs at a small incremental cost, and had an ICER less than $50,000 per QALY gained for men younger than 65 and for women younger than 55. MoM HRA and THA failure rates, device costs, and the difference in quality of life after conversion from HRA to THA compared to primary THA had the largest impact on costs and quality of life.

Conclusions: MoM HRA could be clinically advantageous and cost-effective in younger men and women. Further research on the comparative effectiveness of MoM HRA versus THA should include assessments of the quality of life and resource use in addition to the clinical outcomes associated with both procedures.

Level of evidence: Level I, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence.

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Related in: MedlinePlus

A graph shows a one-way sensitivity analysis to difference in QoL after conversion from HRA to THA compared to primary THA by gender and age strata. The ICER increased rapidly with small differences in the quality of life after conversion of HRA to THA compared to primary THA for men age less than age 55, men age 55 to 64, and women less than age 55. Men, age 55 to 64 had a more favorable (lower) ICER with much smaller change in ICER as the difference in quality of life after conversion from HRA to THA increased.
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Fig3: A graph shows a one-way sensitivity analysis to difference in QoL after conversion from HRA to THA compared to primary THA by gender and age strata. The ICER increased rapidly with small differences in the quality of life after conversion of HRA to THA compared to primary THA for men age less than age 55, men age 55 to 64, and women less than age 55. Men, age 55 to 64 had a more favorable (lower) ICER with much smaller change in ICER as the difference in quality of life after conversion from HRA to THA increased.

Mentions: The variables that had the most influence on the model results were the annual probability of MoM HRA and THA failure, the cost of MoM HRA and THA, operative mortality of MoM HRA and THA, and the QoL after conversion from HRA to THA (Fig. 2). The one-way sensitivity analysis of the ICER to the difference in QoL after conversion from HRA to THA compared to primary THA indicated that the ICER for MoM HRA was very sensitive to the differences in QoL after conversion from HRA to THA for both men and women less than age 55, but not for men age 55–64 (Fig. 3). MoM HRA would be cost-saving over the 30 year time horizon if the incremental cost of the HRA implants compared to the primary THA implants was less than $313 for men aged less than age 55 years, less than $711 for men aged 55 to 64 years, and less than $175 for men aged 65–74 years (Fig. 4). The two-way sensitivity analysis indicated that the impact of the incremental cost of MoM HRA and the difference in QoL on the cost-effectiveness of MoM HRA varied depending on age and gender. In general, over a wide range of values for the QoL reduction after HRA conversion and the incremental cost of HRA conversion, MoM HRA was more favorable compared to THA for men than for women and for younger patients (age less than 55) compared to older patients (age 65 or older) (Fig. 5A–D).Fig. 2


Do the potential benefits of metal-on-metal hip resurfacing justify the increased cost and risk of complications?

Bozic KJ, Pui CM, Ludeman MJ, Vail TP, Silverstein MD - Clin. Orthop. Relat. Res. (2010)

A graph shows a one-way sensitivity analysis to difference in QoL after conversion from HRA to THA compared to primary THA by gender and age strata. The ICER increased rapidly with small differences in the quality of life after conversion of HRA to THA compared to primary THA for men age less than age 55, men age 55 to 64, and women less than age 55. Men, age 55 to 64 had a more favorable (lower) ICER with much smaller change in ICER as the difference in quality of life after conversion from HRA to THA increased.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2914258&req=5

Fig3: A graph shows a one-way sensitivity analysis to difference in QoL after conversion from HRA to THA compared to primary THA by gender and age strata. The ICER increased rapidly with small differences in the quality of life after conversion of HRA to THA compared to primary THA for men age less than age 55, men age 55 to 64, and women less than age 55. Men, age 55 to 64 had a more favorable (lower) ICER with much smaller change in ICER as the difference in quality of life after conversion from HRA to THA increased.
Mentions: The variables that had the most influence on the model results were the annual probability of MoM HRA and THA failure, the cost of MoM HRA and THA, operative mortality of MoM HRA and THA, and the QoL after conversion from HRA to THA (Fig. 2). The one-way sensitivity analysis of the ICER to the difference in QoL after conversion from HRA to THA compared to primary THA indicated that the ICER for MoM HRA was very sensitive to the differences in QoL after conversion from HRA to THA for both men and women less than age 55, but not for men age 55–64 (Fig. 3). MoM HRA would be cost-saving over the 30 year time horizon if the incremental cost of the HRA implants compared to the primary THA implants was less than $313 for men aged less than age 55 years, less than $711 for men aged 55 to 64 years, and less than $175 for men aged 65–74 years (Fig. 4). The two-way sensitivity analysis indicated that the impact of the incremental cost of MoM HRA and the difference in QoL on the cost-effectiveness of MoM HRA varied depending on age and gender. In general, over a wide range of values for the QoL reduction after HRA conversion and the incremental cost of HRA conversion, MoM HRA was more favorable compared to THA for men than for women and for younger patients (age less than 55) compared to older patients (age 65 or older) (Fig. 5A–D).Fig. 2

Bottom Line: However, the cost effectiveness of MoM HRA compared with THA is unclear.We performed sensitivity analyses to evaluate the impact of patient characteristics, clinical outcome probabilities, quality of life and costs on the discounted incremental costs, incremental clinical effectiveness, and the incremental cost-effectiveness ratio (ICER) of HRA compared to THA.Further research on the comparative effectiveness of MoM HRA versus THA should include assessments of the quality of life and resource use in addition to the clinical outcomes associated with both procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus, MU 320W, San Francisco, CA 94143-0728, USA. evin.bozic@ucsf.edu

ABSTRACT

Background: Metal-on-metal hip resurfacing arthroplasty (MoM HRA) may offer potential advantages over total hip arthroplasty (THA) for certain patients with advanced osteoarthritis of the hip. However, the cost effectiveness of MoM HRA compared with THA is unclear.

Questions/purposes: The purpose of this study was to compare the clinical effectiveness and cost-effectiveness of MoM HRA to THA.

Methods: A Markov decision model was constructed to compare the quality-adjusted life-years (QALYs) and costs associated with HRA versus THA from the healthcare system perspective over a 30-year time horizon. We performed sensitivity analyses to evaluate the impact of patient characteristics, clinical outcome probabilities, quality of life and costs on the discounted incremental costs, incremental clinical effectiveness, and the incremental cost-effectiveness ratio (ICER) of HRA compared to THA.

Results: MoM HRA was associated with modest improvements in QALYs at a small incremental cost, and had an ICER less than $50,000 per QALY gained for men younger than 65 and for women younger than 55. MoM HRA and THA failure rates, device costs, and the difference in quality of life after conversion from HRA to THA compared to primary THA had the largest impact on costs and quality of life.

Conclusions: MoM HRA could be clinically advantageous and cost-effective in younger men and women. Further research on the comparative effectiveness of MoM HRA versus THA should include assessments of the quality of life and resource use in addition to the clinical outcomes associated with both procedures.

Level of evidence: Level I, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence.

Show MeSH
Related in: MedlinePlus