Cost-effectiveness of dual-mobility components in patients with displaced femoral neck fractures

Abstract

Aims Total hip arthroplasty (THA) with dual-mobility components (DM-THA) has been shown to decrease the risk of dislocation in the setting of a displaced neck of femur fracture compared to conventional single-bearing THA (SB-THA). This study assesses if the clinical benefit of a reduced dislocation rate can justify the incremental cost increase of DM-THA compared to SB-THA. Methods Costs and benefits were established for patients aged 75 to 79 years over a five-year time period in the base case from the Canadian Health Payer’s perspective. One-way and probabilistic sensitivity analysis assessed the robustness of the base case model conclusions. Results DM-THA was found to be cost-effective, with an estimated incremental cost-effectiveness ratio (ICER) of CAD $46,556 (£27,074) per quality-adjusted life year (QALY). Sensitivity analysis revealed DM-THA was not cost-effective across all age groups in the first two years. DM-THA becomes cost-effective for those aged under 80 years at time periods from five to 15 years, but was not cost-effective for those aged 80 years and over at any timepoint. To be cost-effective at ten years in the base case, DM-THA must reduce the risk of dislocation compared to SB-THA by at least 62%. Probabilistic sensitivity analysis showed DM-THA was 58% likely to be cost-effective in the base case. Conclusion Treating patients with a displaced femoral neck fracture using DM-THA components may be cost-effective compared to SB-THA in patients aged under 80 years. However, future research will help determine if the modelled rates of adverse events hold true. Surgeons should continue to use clinical judgement and consider individual patients’ physiological age and risk factors for dislocation. Cite this article: Bone Joint J 2021;103-B(12):1783–1790.

The association of surgical approach and bearing size and type with dislocation in total hip arthroplasty for acute hip fracture

“…11,[31][32][33][34] DMC may be a cost-effective alternative, at least in fracture patients aged under 80 years. 35 Our results highlight firstly that the surgeon's choice of surgical approach will determine the risk of dislocation, and secondly that DMC might have a more limited role when the direct lateral approach is used. The direct lateral approach is also associated with a lower risk of revision in general at three years, making it a good choice for the individual with a hip fracture in this respect.…”

The prevalence and treatment of osteoporosis in patients undergoing total hip arthroplasty and the levels of biochemical markers of bone turnover

“…Total hip arthroplasty (THA) provides excellent functional recovery for patients with hip disorders, such as hip osteoarthritis (OA) and femoral head necrosis. The number of THAs performed is increasing globally, 1 , 2 and this trend likely contributes to the increasing incidence of periprosthetic fracture, 3 - 5 aseptic loosening, and periprosthetic joint infection, 6 an uncommon but potentially disabling side-effect.…”

Interpreting decision-analytic modelling-based economic evaluations in orthopaedics

“…6 The latter study involved validation of the model by an independent health economist checking on formulae and any other errors. 16 In other fields, there has been a move towards tests of internal validation (in which a replicate of the model, either by an independent researcher or using a different software platform, is used to assess whether consistent results are produced) and external validation (in which model predictions are compared to external data generated from RCTs and other external studies). However, these approaches have not yet been implemented within economic evaluations of orthopaedic interventions.…”

“…Evidence for parameter inputs can be drawn from RCTs, observational studies, or national registry data. For example, in their economic evaluation of dual-mobility components in patients with displaced femoral neck fractures, Montgomery et al 16 estimated key model parameter inputs in the form of revision rates for single-bearing total hip arthroplasty using data from the Australian Orthopaedic Association National Joint Replacement Registry. However, researchers developing decision-analytic models often do not have access to patient-level data.…”

“…In order for the results of decision-analytic modelling-based economic evaluations to gain credence among decision-makers, it will become increasingly important that they are subject to tests of validation. In their economic evaluations of orthopaedic interventions, Hansson et al 6 and Montgomery et al 16 performed tests of face or descriptive validity. The former study included verification of all data with the original sources, a series of diagnostic tests to confirm that the model had correctly applied all formulae, and a review of the calculations and programming.…”