Rubén Ernesto Mújica Mota1. 1. Institute of Health Service Research, University of Exeter Medical School, University of Exeter, Exeter, UK. R.E.Mujica-Mota@exeter.ac.uk
Abstract
OBJECTIVE: To assess the cost-effectiveness of early primary total hip replacement (THR) for functionally independent older adult patients with osteoarthritis (OA) versus 1) nonsurgical therapy followed by THR once the patient has progressed to a functionally dependent state ("delayed THR") and 2) nonsurgical therapy alone ('medical therapy'), from the Italian National Health Service perspective. METHODS: Individual patient data and evidence from published literature on disease progression, economic costs and THR outcomes in OA, including utilities, perioperative mortality rates, prosthesis survival, and costs of prostheses, THR, rehabilitation, follow-up, revision, and nonsurgical management, combined with population life tables, were synthesized in a Markov model of OA. The model represents the lifetime experience of a patient cohort following their treatment choice, discounting costs and benefits (quality-adjusted life-years) at 3% annually. RESULTS: At age 65 years, the incremental cost per quality-adjusted life-year of THR over delayed THR was €987 in men and €466 in women; the figures for delayed THR versus medical therapy were €463 and €82, respectively. Among 80-year-olds, early THR is (extended) dominant. With gradual utility loss after primary THR, delaying surgery may be more appealing in women than in men in their 50s, because longer female life expectancy implies longer latter periods of low health-related quality of life (HRQOL) with early THR. CONCLUSIONS: THR is cost-effective. Patients' HRQOL benefits forgone with delayed THR are worth more than the costs it saves to the Italian National Health Service. This analysis might help to explain women's consistently lower HRQOL by the time of primary operation.
OBJECTIVE: To assess the cost-effectiveness of early primary total hip replacement (THR) for functionally independent older adult patients with osteoarthritis (OA) versus 1) nonsurgical therapy followed by THR once the patient has progressed to a functionally dependent state ("delayed THR") and 2) nonsurgical therapy alone ('medical therapy'), from the Italian National Health Service perspective. METHODS: Individual patient data and evidence from published literature on disease progression, economic costs and THR outcomes in OA, including utilities, perioperative mortality rates, prosthesis survival, and costs of prostheses, THR, rehabilitation, follow-up, revision, and nonsurgical management, combined with population life tables, were synthesized in a Markov model of OA. The model represents the lifetime experience of a patient cohort following their treatment choice, discounting costs and benefits (quality-adjusted life-years) at 3% annually. RESULTS: At age 65 years, the incremental cost per quality-adjusted life-year of THR over delayed THR was €987 in men and €466 in women; the figures for delayed THR versus medical therapy were €463 and €82, respectively. Among 80-year-olds, early THR is (extended) dominant. With gradual utility loss after primary THR, delaying surgery may be more appealing in women than in men in their 50s, because longer female life expectancy implies longer latter periods of low health-related quality of life (HRQOL) with early THR. CONCLUSIONS: THR is cost-effective. Patients' HRQOL benefits forgone with delayed THR are worth more than the costs it saves to the Italian National Health Service. This analysis might help to explain women's consistently lower HRQOL by the time of primary operation.
Authors: Arthur L Malkani; Brian Dilworth; Kevin Ong; Doruk Baykal; Edmund Lau; Theresa N Mackin; Gwo-Chin Lee Journal: Clin Orthop Relat Res Date: 2017-12 Impact factor: 4.176
Authors: Ryan S Marder; Ian Gopie; Chibuokem P Ikwuazom; Declan Tozzi; Neil V Shah; Qais Naziri; Aditya V Maheshwari Journal: Eur J Orthop Surg Traumatol Date: 2022-06-05
Authors: Cerys Joyce Tassinari; Ruchi Higham; Isabelle Louise Smith; Susanne Arnold; Ruben Mujica-Mota; Andrew Metcalfe; Hamish Simpson; David Murray; Dennis G McGonagle; Hemant Sharma; Thomas William Hamilton; David R Ellard; Catherine Fernandez; Catherine Reynolds; Paul Harwood; Julie Croft; Deborah D Stocken; Hemant Pandit Journal: BMJ Open Date: 2022-06-30 Impact factor: 3.006
Authors: Lane Koenig; Qian Zhang; Matthew S Austin; Berna Demiralp; Thomas K Fehring; Chaoling Feng; Richard C Mather; Jennifer T Nguyen; Asha Saavoss; Bryan D Springer; Adolph J Yates Journal: Clin Orthop Relat Res Date: 2016-10-03 Impact factor: 4.176