H Dakin1, P Eibich1,2, D Beard3, A Gray1, A Price3. 1. Nuffield Department of Population Health, University of Oxford, Oxford, UK. 2. Max Planck Institute for Demographic Research, Rostock, Germany. 3. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, NIHR Biomedical Research Unit, University of Oxford, Oxford, UK.
Abstract
AIMS: To assess how the cost-effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) varies with age, sex, and preoperative Oxford Hip or Knee Score (OHS/OKS); and to identify the patient groups for whom THA/TKA is cost-effective. METHODS: We conducted a cost-effectiveness analysis using a Markov model from a United Kingdom NHS perspective, informed by published analyses of patient-level data. We assessed the cost-effectiveness of THA and TKA in adults with hip or knee osteoarthritis compared with having no arthroplasty surgery during the ten-year time horizon. RESULTS: THA and TKA cost < £7,000 per quality-adjusted life-year (QALY) gained at all preoperative scores below the absolute referral thresholds calculated previously (40 for OHS and 41 for OKS). Furthermore, THA cost < £20,000/QALY for patients with OHS of ≤ 45, while TKA was cost-effective for patients with OKS of ≤ 43, since the small improvements in quality of life outweighed the cost of surgery and any subsequent revisions. Probabilistic and one-way sensitivity analyses demonstrated that there is little uncertainty around the conclusions. CONCLUSION: If society is willing to pay £20,000 per QALY gained, THA and TKA are cost-effective for nearly all patients who currently undergo surgery, including all patients at and above our calculated absolute referral thresholds. Cite this article: Bone Joint J 2020;102-B(7):950-958.
AIMS: To assess how the cost-effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) varies with age, sex, and preoperative Oxford Hip or Knee Score (OHS/OKS); and to identify the patient groups for whom THA/TKA is cost-effective. METHODS: We conducted a cost-effectiveness analysis using a Markov model from a United Kingdom NHS perspective, informed by published analyses of patient-level data. We assessed the cost-effectiveness of THA and TKA in adults with hip or knee osteoarthritis compared with having no arthroplasty surgery during the ten-year time horizon. RESULTS: THA and TKA cost < £7,000 per quality-adjusted life-year (QALY) gained at all preoperative scores below the absolute referral thresholds calculated previously (40 for OHS and 41 for OKS). Furthermore, THA cost < £20,000/QALY for patients with OHS of ≤ 45, while TKA was cost-effective for patients with OKS of ≤ 43, since the small improvements in quality of life outweighed the cost of surgery and any subsequent revisions. Probabilistic and one-way sensitivity analyses demonstrated that there is little uncertainty around the conclusions. CONCLUSION: If society is willing to pay £20,000 per QALY gained, THA and TKA are cost-effective for nearly all patients who currently undergo surgery, including all patients at and above our calculated absolute referral thresholds. Cite this article: Bone Joint J 2020;102-B(7):950-958.
Authors: Andrew J Price; Sujin Kang; Jonathan A Cook; Helen Dakin; Ashley Blom; Nigel Arden; Ray Fitzpatrick; David J Beard Journal: Bone Joint J Date: 2020-07 Impact factor: 5.082
Authors: Andrew J Price; Sujin Kang; Jonathan A Cook; Helen Dakin; Ashley Blom; Nigel Arden; Ray Fitzpatrick; David J Beard Journal: Bone Joint J Date: 2020-07 Impact factor: 5.082
Authors: Thomas C Edwards; Brogan Guest; Amy Garner; Kartik Logishetty; Alexander D Liddle; Justin P Cobb Journal: Bone Joint Res Date: 2022-05 Impact factor: 4.410
Authors: Helen A Dakin; Peter Eibich; Alastair Gray; James Smith; Karen L Barker; David Beard; Andrew J Price Journal: BMJ Open Date: 2020-07-02 Impact factor: 2.692
Authors: Lindsay K Smith; Cesar Garriga; Sarah R Kingsbury; Rafael Pinedo-Villanueva; Antonella Delmestri; Nigel K Arden; Martin Stone; Philip G Conaghan; Andrew Judge Journal: BMJ Open Date: 2022-03-09 Impact factor: 2.692