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. 2012 May 25;2(3):e000752.
doi: 10.1136/bmjopen-2011-000752. Print 2012.

The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study

Richard Fordham  1 , Jane Skinner, Xia Wang, John Nolan; Exeter Primary Outcome Study Group
Affiliations

The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study

Richard Fordham et al. BMJ Open. .

Abstract

Objectives: To assess changes in quality of life and costs of patients undergoing primary total hip replacement using the Exeter prosthesis compared with a hypothetical 'no surgery' group.

Design: The incremental quality of life, quality-adjusted life years (QALYs) and cost of Exeter Primary Outcomes Study patients was compared with hypothetical 'no surgery' group over 5 years. Scores from annual SF-36 assessments were converted into utility scores using an established algorithm and the QALY gains calculated from pre-operative baseline scores. Costs included implant costs and length of stay.

Setting: Secondary care hospitals.

Participants: Patients receiving a primary Exeter implant enrolled in five of seven Exeter Primary Outcomes Study centres.

Results: On average, patients gained around 0.8 QALYs over 5 years. Younger and male patients or those with lower body mass index and poorer Oxford Hip Scores were significantly associated with increased QALYs. Treatment costs for a primary episode of care were just over £5000 (95% CI £4588 to £5812) per patient. Compared with 'no surgery', the cost per QALY was £7182 (95% CI £6470 to £7678), and this remained stable when key cost parameters were varied. The most likely cost per QALY was between £7058 and £7220. Older patients (age 75+) cost more, mainly due to longer average hospital stays and had a higher cost per QALY, although this remained below £10 000.

Conclusions: 85% of cases had a cost of <£20 000 per QALY (with 70% having a cost per QALY under £10 000) compared with no surgery. Cases would be considered cost-effective under currently accepted thresholds (£25 000-£30 000) compared with 'no surgery'. However, depending on age and severity, younger patients and more severe patients had below average cost per QALYs. These results help to confirm the long-term benefits and cost-effectiveness of total hip replacement in a wide variety of patients using well-established implant models such as the Exeter. However, further and ongoing economic appraisal of this and other models is required for comparative purposes.

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Conflict of interest statement

Competing interests: RF and JS received consultancy payments for the original economic analysis. RF is currently receiving a 2-year study grant from Stryker to undertake further work on the Outcomes and Costs of Hip Replacement evaluation (the ‘OCHRE’) project looking at long-term cost-effectiveness of the Exeter prosthesis.

Figures

Figure 1
Figure 1
Schematic calculation of quality-adjusted life years (QALYs).
Figure 2
Figure 2
Utility score by baseline and subsequent year.
Figure 3
Figure 3
Quality-adjusted life years (QALYs) gained in Exeter Primary Outcomes Study patients up to 5 years.
Figure 4
Figure 4
Cost of primary hip replacement in Exeter Primary Outcomes Study patients.
Figure 5
Figure 5
Probabilistic sensitivity analysis.
See this image and copyright information in PMC

References

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