Predicting the cost-effectiveness of total hip and knee replacement

Jenkins, P; Clement, Nicholas D.; Hamilton, David F.; Gaston, Paul; Patton, James T.; Howie, C. R.

doi:10.1302/0301-620x.95b1.29835

Cited by 291 publications

(248 citation statements)

References 25 publications

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“…Using these tariffs a recent report found an average cost per QALY gained to be £5,623 for the first five years after surgery [14]. Another study analysed the cost per QALY for the life expectancy of their patient cohort and demonstrated a cost per QALY of £4,704, accounting for deterioration in outcome with time and potential revision of the costs [2]. There is consensus then that the cost per QALY for knee arthroplasty is far below the value of £20,000 suggested by the UK national institute for clinical excellence as the threshold by which interventions are deemed cost effective [15].…”

Section: Discussionmentioning

confidence: 99%

“…This methodology assumes static health after oneyear and no need for further intervention, which is considered the undiscounted health gain [8]. The QALYs gain was discounted at a rate of 5 % for each year of life expectancy to reflect a diminishing gain with time [9], as has been previously employed in arthroplasty health economic analysis [2]. The cost per QALY was then calculated (QALY gained/cost of prosthesis) at one year and for the expected lifetime of the cohort (adjusted and unadjusted).…”

Section: Study Population and Trial Designmentioning

confidence: 99%

“…Cost effectiveness is an increasingly important factor in today's healthcare environment, and decisions surrounding the choice of arthroplasty prostheses to implant are not exempt from such health economic concerns. Recently, Jenkins et al [2] demonstrated that TKA was a cost-effective intervention, with a cost per quality adjusted life years (QALY) of £2,101. They intimated that innovations in implant design could influence the economics, with improved outcomes potentially leading to lower costs per QALY gained.…”

Section: Introductionmentioning

confidence: 99%

“…It could be argued however that the differences reported in EuroQol-5D, though not clinically significant, may be significant from a health economic perspective. Assuming the implants were purchased at the same list price, the 0.023 point difference found between the NexGen (Zimmer) and the Genesis 2 (Smith & Nephew) would result in a £2,000 difference in cost per QALY at one year and £145 difference in the lifetime cost per QALY, using the methodology established by Jenkins et al [2]. If such a difference potentially exists between modern implants, there may well be differences comparing new implant technology to older designs.…”

Section: Introductionmentioning

confidence: 99%

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Do modern total knee replacements offer better value for money? A health economic analysis

Hamilton

Clement

Burnett

et al. 2013

International Orthopaedics (SICOT)

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Purpose Cost effectiveness is an increasingly important factor in today's healthcare environment, and selection of arthroplasty implant is not exempt from such concerns. Quality adjusted life years (QALYs) are the typical tool for this type of evaluation. Using this methodology, joint arthroplasty has been shown to be cost effective; however, studies directly comparing differing prostheses are lacking. Methods Data was gathered in a single-centre prospective double-blind randomised controlled trial comparing the outcome of modern and traditional knee implants, using the Short Form 6 dimensional (SF-6D) score and quality adjusted life year (QALY) methodology. Results There was significant improvement in the SF-6D score for both groups at one year (p<0.0001). The calculated overall life expectancy for the study cohort was 15.1 years, resulting in an overall QALY gain of 2.144 (95 % CI 1.752-2.507). The modern implant group demonstrated a small improvement in SF-6D score compared to the traditional design at one year (0.141 versus 0.143, p=0.94). This difference resulted in the modern implant costing £298 less per QALY at one year. Conclusion This study demonstrates that modern implant technology does not influence the cost-effectiveness of TKA using the SF-6D and QALY methodology. This type of analysis however assesses health status, and is not sensitive to joint specific function. Evolutionary design changes in implant technology are thus unlikely to influence QALY analysis following joint replacement, which has important implications for implant procurement.

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Section: Discussionmentioning

confidence: 99%

Section: Study Population and Trial Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Do modern total knee replacements offer better value for money? A health economic analysis

Hamilton

Clement

Burnett

et al. 2013

International Orthopaedics (SICOT)

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“…Total hip arthroplasty (THA) is one of the most commonly performed and cost-effective orthopedic procedures [1,2]. By 2030, the number of primary THA in the United States is estimated to rise by 174% to 572,000 procedures [3].…”

mentioning

confidence: 99%

Preoperative Pain Level and Patient Expectation Predict Hospital Length of Stay After Total Hip Arthroplasty

Halawi

Vovos

Green

et al. 2015

The Journal of Arthroplasty

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a b s t r a c t a r t i c l e i n f oThe purpose of this study was to identify preoperative predictors of length of stay after primary total hip arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A retrospective review of 112 consecutive patients was performed. High preoperative pain level and patient expectation of discharge to extended care facilities (ECFs) were the only significant multivariable predictors of hospitalization extending beyond 2 days (P = 0.001 and P b 0.001 respectively). Patient expectation remained significant after adjusting for Medicare's 3-day requirement for discharge to ECFs (P b 0.001). The study was adequately powered to analyze the variables in the multivariable logistic regression model, which had a concordance index of 0.857.

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Costs of Joint Replacement in Osteoarthritis: A Study Using the National Joint Registry and Clinical Practice Research Datalink Data Sets

Leal

Murphy

Garriga

et al. 2022

Arthritis Care & Research

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Objective. To estimate the costs of primary hip and knee replacement in individuals with osteoarthritis up to 2 years postsurgery, compare costs before and after the surgery, and identify predictors of hospital costs.Methods. Patients age ≥18 years with primary planned hip or knee replacements and osteoarthritis in England between 2008 and 2016 were identified from the National Joint Registry and linked with Hospital Episode Statistics data containing inpatient episodes. Primary care data linked with hospital outpatient records were also used to identify patients age ≥18 years with primary hip or knee replacements between 2008 and 2016. All health care resource use was valued using 2016/2017 costs, and nonparametric censoring methods were used to estimate total 1-year and 2-year costs.Results. We identified 854,866 individuals undergoing hip or knee replacement. The mean censor-adjusted 1-year hospitalization costs for hip and knee replacement were £7,827 (95% confidence interval [95% CI] 7,813, 7,842) and £7,805 (95% CI 7,790, 7,818), respectively. Complications and revisions were associated with up to a 3-fold increase in 1-year hospitalization costs. The censor-adjusted 2-year costs were £9,258 (95% CI 9,233, 9,280) and £9,452 (95% CI 9,430, 9,475) for hip and knee replacement, respectively. Adding primary and outpatient care, the mean total hip and knee replacement 2-year costs were £11,987 and £12,578, respectively.Conclusion. There are significant costs following joint replacement. Revisions and complications accounted for considerable costs and there is a significant incentive to identify best approaches to reduce these.

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Predicting the cost-effectiveness of total hip and knee replacement

Cited by 291 publications

References 25 publications

Do modern total knee replacements offer better value for money? A health economic analysis

Do modern total knee replacements offer better value for money? A health economic analysis

Preoperative Pain Level and Patient Expectation Predict Hospital Length of Stay After Total Hip Arthroplasty

Costs of Joint Replacement in Osteoarthritis: A Study Using the National Joint Registry and Clinical Practice Research Datalink Data Sets

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