Cost-effectiveness of timely versus delayed primary total hip replacement in Germany: A social health insurance perspective

Abstract

Without clinical guideline on the optimal timing for primary total hip replacement (THR), patients often receive the operation with delay. Delaying THR may negatively affect long-term health-related quality of life, but its economic effects are unclear. We evaluated the costs and health benefits of timely primary THR for functionally independent adult patients with end-stage osteoarthritis (OA) compared to non-surgical therapy followed by THR after progression to functional dependence (delayed THR), and non-surgical therapy alone (Medical Therapy), from a German Social Health Insurance (SHI) perspective. Data from hip arthroplasty registers and a systematic review of the published literature were used to populate a tunnel-state modified Markov lifetime model of OA treatment in Germany. A 5% annual discount rate was applied to costs (2013 prices) and health outcomes (Quality Adjusted Life Years, QALY). The expected future average cost of timely THR, delayed THR and medical therapy in women at age 55 were €27,474, €27,083 and €28,263, and QALYs were 20.7, 16.7, and 10.3, respectively. QALY differences were entirely due to health-related quality of life differences. The discounted cost per QALY gained by timely over delayed (median delay of 11 years) THR was €1270 and €1338 in women treated at age 55 and age 65, respectively, and slightly higher than this for men. Timely THR is cost-effective, generating large quality of life benefits for patients at low additional cost to the SHI. With declining healthcare budgets, research is needed to identify the characteristics of those able to benefit the most from timely THR.

Cost effectiveness analyses of total hip arthroplasty for hip osteoarthritis: A PRISMA systematic review

“…Analyses where ICER was not included were predominantly carried out in the UK (n = 3, 60%) 38‐40 . Studies where willingness to pay was not included were mainly either Canadian (n = 3, 33.3%), 29‐31 American (n = 2, 20%) 28,33 or German (n = 2, 20%) 46,47 . All studies conducted in the UK had a WTP threshold of £20 000, while all studies conducted in Canada had a WTP threshold of $50 000.…”

Disease registry system in northwest of Iran: The first step forward in research progress with review of literature

“…For example, growth hormone registry systems should be followed up in target patients from childhood to adolescence. 13 In addition, registration systems are also used to assess the costeffectiveness, a tool for describing the comparative value of a product or healthcare service. 13 The cost analysis shows the benefits of an intervention in terms of its cost.…”

“…13 In addition, registration systems are also used to assess the costeffectiveness, a tool for describing the comparative value of a product or healthcare service. 13 The cost analysis shows the benefits of an intervention in terms of its cost. For example, by analyzing the cost of joint replacement surgery, the annual cost of delay in re-surgical joint replacement can be obtained.…”

“…For example, by analyzing the cost of joint replacement surgery, the annual cost of delay in re-surgical joint replacement can be obtained. 13,14 Registration systems may be developed to evaluate patient safety. 9 Here, by safety we imply the patient safety.…”

“…In general, the patient safety record system is an active monitoring tool to indicate the harmful events for the patients induced by services or products. [9][10][11][12][13][14][15] Registration systems can assess the quality as well. Institute of Medicine (IOM) defines quality as a degree to which the health services increase the chance of health-related outcomes in accordance with professional knowledge.…”