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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

An acceptability curve from the probabilistic sensitivity analysis shows the probability that ICER is below a particular willingness to pay threshold based on the simulation using 10,000 samples for each gender and age stratum. The probability (confidence) that the ICER was less than or equal to $100,000 per QALY gained was only 63% for men less than age 55, 75% for men ages 55–64, and 68% for women less than age 55. The probabilities were lower for the remaining three strata. The uncertainty illustrated by these acceptability curves indicates that variation in costs of HRA, failure rates of HRA and THA, and quality of life difference after conversion of HRA to THA have a large impact on the comparative clinical and cost-effectiveness of MoM HRA.
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Fig6: An acceptability curve from the probabilistic sensitivity analysis shows the probability that ICER is below a particular willingness to pay threshold based on the simulation using 10,000 samples for each gender and age stratum. The probability (confidence) that the ICER was less than or equal to $100,000 per QALY gained was only 63% for men less than age 55, 75% for men ages 55–64, and 68% for women less than age 55. The probabilities were lower for the remaining three strata. The uncertainty illustrated by these acceptability curves indicates that variation in costs of HRA, failure rates of HRA and THA, and quality of life difference after conversion of HRA to THA have a large impact on the comparative clinical and cost-effectiveness of MoM HRA.

Mentions: The probabilistic sensitivity analysis demonstrated wide variation in the ICERs due to the overall simultaneous variation in the many underlying factors that may influence the clinical effectiveness and costs of MoM HRA and THA (Table 3). The acceptability curves can be interpreted as the probability (or confidence) that the ICER is less than a certain willingness to pay threshold. The probabilities that the ICERs are less than or equal to $100,000 per QALY were less than 75% for all strata (Fig. 6), indicating that variation in costs of HRA, failure rates of HRA and THA, and quality of life difference after conversion of HRA to THA have a large impact on the cost and clinical effectiveness of MoM HRA compared to THA. However, it should be noted that the impact is similar for each age and gender strata and unlikely to change the age and gender specific ranking of the incremental cost and clinical effectiveness of MoM HRA compared to THA.Fig. 6


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)

An acceptability curve from the probabilistic sensitivity analysis shows the probability that ICER is below a particular willingness to pay threshold based on the simulation using 10,000 samples for each gender and age stratum. The probability (confidence) that the ICER was less than or equal to $100,000 per QALY gained was only 63% for men less than age 55, 75% for men ages 55–64, and 68% for women less than age 55. The probabilities were lower for the remaining three strata. The uncertainty illustrated by these acceptability curves indicates that variation in costs of HRA, failure rates of HRA and THA, and quality of life difference after conversion of HRA to THA have a large impact on the comparative clinical and cost-effectiveness of MoM HRA.
© Copyright Policy
Related In: Results  -  Collection

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

Fig6: An acceptability curve from the probabilistic sensitivity analysis shows the probability that ICER is below a particular willingness to pay threshold based on the simulation using 10,000 samples for each gender and age stratum. The probability (confidence) that the ICER was less than or equal to $100,000 per QALY gained was only 63% for men less than age 55, 75% for men ages 55–64, and 68% for women less than age 55. The probabilities were lower for the remaining three strata. The uncertainty illustrated by these acceptability curves indicates that variation in costs of HRA, failure rates of HRA and THA, and quality of life difference after conversion of HRA to THA have a large impact on the comparative clinical and cost-effectiveness of MoM HRA.
Mentions: The probabilistic sensitivity analysis demonstrated wide variation in the ICERs due to the overall simultaneous variation in the many underlying factors that may influence the clinical effectiveness and costs of MoM HRA and THA (Table 3). The acceptability curves can be interpreted as the probability (or confidence) that the ICER is less than a certain willingness to pay threshold. The probabilities that the ICERs are less than or equal to $100,000 per QALY were less than 75% for all strata (Fig. 6), indicating that variation in costs of HRA, failure rates of HRA and THA, and quality of life difference after conversion of HRA to THA have a large impact on the cost and clinical effectiveness of MoM HRA compared to THA. However, it should be noted that the impact is similar for each age and gender strata and unlikely to change the age and gender specific ranking of the incremental cost and clinical effectiveness of MoM HRA compared to THA.Fig. 6

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