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The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study.

Fordham R, Skinner J, Wang X, Nolan J, Exeter Primary Outcome Study Gro - BMJ Open (2012)

Bottom Line: Younger and male patients or those with lower body mass index and poorer Oxford Hip Scores were significantly associated with increased QALYs.These results help to confirm the long-term benefits and cost-effectiveness of total hip replacement in a wide variety of patients using well-established implant models such as the Exeter.However, further and ongoing economic appraisal of this and other models is required for comparative purposes.

View Article: PubMed Central - PubMed

Affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.

ABSTRACT

Objectives: To assess changes in quality of life and costs of patients undergoing primary total hip replacement using the Exeter prosthesis compared with a hypothetical 'no surgery' group.

Design: The incremental quality of life, quality-adjusted life years (QALYs) and cost of Exeter Primary Outcomes Study patients was compared with hypothetical 'no surgery' group over 5 years. Scores from annual SF-36 assessments were converted into utility scores using an established algorithm and the QALY gains calculated from pre-operative baseline scores. Costs included implant costs and length of stay.

Setting: Secondary care hospitals.

Participants: Patients receiving a primary Exeter implant enrolled in five of seven Exeter Primary Outcomes Study centres.

Results: On average, patients gained around 0.8 QALYs over 5 years. Younger and male patients or those with lower body mass index and poorer Oxford Hip Scores were significantly associated with increased QALYs. Treatment costs for a primary episode of care were just over £5000 (95% CI £4588 to £5812) per patient. Compared with 'no surgery', the cost per QALY was £7182 (95% CI £6470 to £7678), and this remained stable when key cost parameters were varied. The most likely cost per QALY was between £7058 and £7220. Older patients (age 75+) cost more, mainly due to longer average hospital stays and had a higher cost per QALY, although this remained below £10 000.

Conclusions: 85% of cases had a cost of <£20 000 per QALY (with 70% having a cost per QALY under £10 000) compared with no surgery. Cases would be considered cost-effective under currently accepted thresholds (£25 000-£30 000) compared with 'no surgery'. However, depending on age and severity, younger patients and more severe patients had below average cost per QALYs. These results help to confirm the long-term benefits and cost-effectiveness of total hip replacement in a wide variety of patients using well-established implant models such as the Exeter. However, further and ongoing economic appraisal of this and other models is required for comparative purposes.

No MeSH data available.


Related in: MedlinePlus

Schematic calculation of quality-adjusted life years (QALYs).
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fig1: Schematic calculation of quality-adjusted life years (QALYs).

Mentions: We calculated QALY gains made each year compared with the pre-operative baseline using an ‘area under the curve’ approach (see figure 1). In reality, other treatments might have improved this baseline score and reduced the net potential utility gain found in this study. On the other hand, we might have assumed the condition worsened. The direction of change could not be known with any certainty and therefore we assumed that no change occurred in QoL from baseline over the 5-year period. The QALY gain per patient was calculated up to the 5-year follow-up period or until the last annual review before death or revision (whichever occurred first). As the EPOS excluded patients who had revisions, we could only assume a zero QoL gain after revision had taken place (although this would be likely to be higher).


The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study.

Fordham R, Skinner J, Wang X, Nolan J, Exeter Primary Outcome Study Gro - BMJ Open (2012)

Schematic calculation of quality-adjusted life years (QALYs).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3367151&req=5

fig1: Schematic calculation of quality-adjusted life years (QALYs).
Mentions: We calculated QALY gains made each year compared with the pre-operative baseline using an ‘area under the curve’ approach (see figure 1). In reality, other treatments might have improved this baseline score and reduced the net potential utility gain found in this study. On the other hand, we might have assumed the condition worsened. The direction of change could not be known with any certainty and therefore we assumed that no change occurred in QoL from baseline over the 5-year period. The QALY gain per patient was calculated up to the 5-year follow-up period or until the last annual review before death or revision (whichever occurred first). As the EPOS excluded patients who had revisions, we could only assume a zero QoL gain after revision had taken place (although this would be likely to be higher).

Bottom Line: Younger and male patients or those with lower body mass index and poorer Oxford Hip Scores were significantly associated with increased QALYs.These results help to confirm the long-term benefits and cost-effectiveness of total hip replacement in a wide variety of patients using well-established implant models such as the Exeter.However, further and ongoing economic appraisal of this and other models is required for comparative purposes.

View Article: PubMed Central - PubMed

Affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.

ABSTRACT

Objectives: To assess changes in quality of life and costs of patients undergoing primary total hip replacement using the Exeter prosthesis compared with a hypothetical 'no surgery' group.

Design: The incremental quality of life, quality-adjusted life years (QALYs) and cost of Exeter Primary Outcomes Study patients was compared with hypothetical 'no surgery' group over 5 years. Scores from annual SF-36 assessments were converted into utility scores using an established algorithm and the QALY gains calculated from pre-operative baseline scores. Costs included implant costs and length of stay.

Setting: Secondary care hospitals.

Participants: Patients receiving a primary Exeter implant enrolled in five of seven Exeter Primary Outcomes Study centres.

Results: On average, patients gained around 0.8 QALYs over 5 years. Younger and male patients or those with lower body mass index and poorer Oxford Hip Scores were significantly associated with increased QALYs. Treatment costs for a primary episode of care were just over £5000 (95% CI £4588 to £5812) per patient. Compared with 'no surgery', the cost per QALY was £7182 (95% CI £6470 to £7678), and this remained stable when key cost parameters were varied. The most likely cost per QALY was between £7058 and £7220. Older patients (age 75+) cost more, mainly due to longer average hospital stays and had a higher cost per QALY, although this remained below £10 000.

Conclusions: 85% of cases had a cost of <£20 000 per QALY (with 70% having a cost per QALY under £10 000) compared with no surgery. Cases would be considered cost-effective under currently accepted thresholds (£25 000-£30 000) compared with 'no surgery'. However, depending on age and severity, younger patients and more severe patients had below average cost per QALYs. These results help to confirm the long-term benefits and cost-effectiveness of total hip replacement in a wide variety of patients using well-established implant models such as the Exeter. However, further and ongoing economic appraisal of this and other models is required for comparative purposes.

No MeSH data available.


Related in: MedlinePlus