OBJECTIVE: To estimate the average cost per quality adjusted life year (QALY) gained from hip surgery, and to examine the variation in that between hospitals. DESIGN: The transformation of patient-reported outcome measures (EQ-5D data) into QALYs, covering 25,463 NHS patient episodes between April 2009 and August 2010 from hospitals in England, using a model of future health change arising from a hip operation compared to a counterfactual of no operation. Hospital-level costs for hip procedures from the National Reference Costs data-set was used to calculate the hospitals' cost per QALY. SETTING: English hospitals treating NHS-funded patients undergoing hip replacement. PARTICIPANTS: NHS-funded patients undergoing primary hip replacement. MAIN OUTCOME MEASURE: Cost per QALY. RESULTS: Assuming some degradation in patients' health over the lifetime of the hip prosthesis, average health gain arising from a hip operation was 2.77 QALYs. For procedures paid for by the NHS but carried out in the independent sector the average gain was 2.97 QALYs. Average NHS hospital hip procedure costs were estimated to be £5844. The unweighted average cost per QALY for NHS hospitals was £2128. There were significant variations in cost per QALY between hospitals; most of this variation appears to be driven by variations in cost, not QALYs. CONCLUSIONS: Using the new patient-assessed health-related quality of life data combined with routine hospital-level cost data it is possible to estimate a procedure-based measure of efficiency for hospitals. The fact that variations in cost per QALY are strongly driven by variations in cost suggests that further work is needed to investigate the causes of cost variations per se--especially the quality of routine NHS cost data.
OBJECTIVE: To estimate the average cost per quality adjusted life year (QALY) gained from hip surgery, and to examine the variation in that between hospitals. DESIGN: The transformation of patient-reported outcome measures (EQ-5D data) into QALYs, covering 25,463 NHS patient episodes between April 2009 and August 2010 from hospitals in England, using a model of future health change arising from a hip operation compared to a counterfactual of no operation. Hospital-level costs for hip procedures from the National Reference Costs data-set was used to calculate the hospitals' cost per QALY. SETTING: English hospitals treating NHS-funded patients undergoing hip replacement. PARTICIPANTS: NHS-funded patients undergoing primary hip replacement. MAIN OUTCOME MEASURE: Cost per QALY. RESULTS: Assuming some degradation in patients' health over the lifetime of the hip prosthesis, average health gain arising from a hip operation was 2.77 QALYs. For procedures paid for by the NHS but carried out in the independent sector the average gain was 2.97 QALYs. Average NHS hospital hip procedure costs were estimated to be £5844. The unweighted average cost per QALY for NHS hospitals was £2128. There were significant variations in cost per QALY between hospitals; most of this variation appears to be driven by variations in cost, not QALYs. CONCLUSIONS: Using the new patient-assessed health-related quality of life data combined with routine hospital-level cost data it is possible to estimate a procedure-based measure of efficiency for hospitals. The fact that variations in cost per QALY are strongly driven by variations in cost suggests that further work is needed to investigate the causes of cost variations per se--especially the quality of routine NHS cost data.
Entities:
Keywords:
cost effectiveness; cost per QALY; health economics; hip replacement; orthopaedics; patient reported outcome measures (PROMs)
Authors: Andrew Hutchings; Kirstin Grosse Frie; Jenny Neuburger; Jan van der Meulen; Nick Black Journal: J Clin Epidemiol Date: 2012-11-28 Impact factor: 6.437
Authors: H Osnes-Ringen; M K Kvamme; I S Kristiansen; M Thingstad; J E Henriksen; T K Kvien; H Dagfinrud Journal: Scand J Rheumatol Date: 2011-01-17 Impact factor: 3.641
Authors: Nils Gutacker; Chris Bojke; Silvio Daidone; Nancy J Devlin; David Parkin; Andrew Street Journal: Health Econ Date: 2012-09-10 Impact factor: 3.046
Authors: Anthony Culyer; Christopher McCabe; Andrew Briggs; Karl Claxton; Martin Buxton; Ron Akehurst; Mark Sculpher; John Brazier Journal: J Health Serv Res Policy Date: 2007-01
Authors: Andrew Hutchings; Jenny Neuburger; Kirstin Grosse Frie; Nick Black; Jan van der Meulen Journal: Health Qual Life Outcomes Date: 2012-03-30 Impact factor: 3.186
Authors: Aureliano Paolo Finch; Eva Gamper; Richard Norman; Rosalie Viney; Bernhard Holzner; Madeleine King; Georg Kemmler Journal: Pharmacoeconomics Date: 2021-07-03 Impact factor: 4.981