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Objective To compare the cost effectiveness of the three most commonly chosen types of prosthesis for total hip replacement.Design Lifetime cost effectiveness model with parameters estimated from individual patient data obtained from three large national databases. Setting English National Health Service.Participants Adults aged 55 to 84 undergoing primary total hip replacement for osteoarthritis.Interventions Total hip replacement using either cemented, cementless, or hybrid prostheses. Cost (£), quality of life (EQ-5D-3L, where 0 represents death and 1 perfect health), quality adjusted life years (QALYs), incremental cost effectiveness ratios, and the probability that each prosthesis type is the most cost effective at alternative thresholds of willingness to pay for a QALY gain. Main outcome measuresResults Lifetime costs were generally lowest with cemented prostheses, and postoperative quality of life and lifetime QALYs were highest with hybrid prostheses. For example, in women aged 70 mean costs were £6900 ($11 000; €8200) for cemented prostheses, £7800 for cementless prostheses, and £7500 for hybrid prostheses; mean postoperative EQ-5D scores were 0.78, 0.80, and 0.81, and the corresponding lifetime QALYs were 9.0, 9.2, and 9.3 years. The incremental cost per QALY for hybrid compared with cemented prostheses was £2500. If the threshold willingness to pay for a QALY gain exceeded £10 000, the probability that hybrid prostheses were most cost effective was about 70%. Hybrid prostheses have the highest probability of being the most cost effective in all subgroups, except in women aged 80, where cemented prostheses were most cost effective. ConclusionsCemented prostheses were the least costly type for total hip replacement, but for most patient groups hybrid prostheses were the most cost effective. Cementless prostheses did not provide sufficient improvement in health outcomes to justify their additional costs. IntroductionTotal hip replacement is one of the most common surgical procedures. In 2010 the global market for hip prostheses was estimated at $4.7b (£3.0b; €3.5b).1 A large number of different prosthesis designs have been developed and introduced on the market. For example, in England and Wales in 2010 at least 123 different brands of acetabular cups and 146 brands of femoral stems were used.2 These prosthesis brands are often grouped into cemented, cementless, and hybrid prostheses. Hybrid prostheses consist of cemented stems and cementless cups.Cementless prostheses, although the most expensive, have become the most common type of prosthesis used for total hip replacement in England, Wales, Italy, Australia, Canada, and the United States, with hybrid prostheses growing in popularity. [2][3][4][5][6] The increasing use of cementless components has contributed to a doubling of prosthesis costs between 1996 and 2006. 7 Although a recent study analysing data from the National Joint Registry for England and Wales, the largest orthopaedic registry in the world, suggested that cementless prosthese...

Evidence from the largest survey on the value of health gains by the general public indicated a higher value for life extending gains compared with QoL enhancing gains. A further modest premium may be indicated for life extension when facing imminent, premature death.

SPC delivered in specialist as compared with general practice will result in greater stability of clinical attachment but this will be achieved at relatively greater cost.

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A CIP catalogue record for this book is available from the British Library. Many IEA publications are translated into languages other than English or are reprinted. Permission to translate or to reprint should be sought from the

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Modelling the available clinical and cost data indicates that, root canal treatment is highly cost-effective as a first line intervention. Orthograde re-treatment is also cost-effective, if a root treatment subsequently fails, but surgical re-treatment is not. Implants may have a role as a third line intervention if re-treatment fails.