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Comparative Study
. 2013 Feb 27:346:f1026.
doi: 10.1136/bmj.f1026.

Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis

Mark Pennington  1 , Richard Grieve, Jasjeet S Sekhon, Paul Gregg, Nick Black, Jan H van der Meulen
Affiliations
Comparative Study

Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis

Mark Pennington et al. BMJ. .

Abstract

Objective: To compare the cost effectiveness of the three most commonly chosen types of prosthesis for total hip replacement.

Design: Lifetime cost effectiveness model with parameters estimated from individual patient data obtained from three large national databases.

Setting: English National Health Service.

Participants: Adults aged 55 to 84 undergoing primary total hip replacement for osteoarthritis.

Interventions: Total hip replacement using either cemented, cementless, or hybrid prostheses.

Main outcome measures: Cost (£), quality of life (EQ-5D-3L, where 0 represents death and 1 perfect health), quality adjusted life years (QALYs), incremental cost effectiveness ratios, and the probability that each prosthesis type is the most cost effective at alternative thresholds of willingness to pay for a QALY gain.

Results: Lifetime costs were generally lowest with cemented prostheses, and postoperative quality of life and lifetime QALYs were highest with hybrid prostheses. For example, in women aged 70 mean costs were £6900 ($11 000; €8200) for cemented prostheses, £7800 for cementless prostheses, and £7500 for hybrid prostheses; mean postoperative EQ-5D scores were 0.78, 0.80, and 0.81, and the corresponding lifetime QALYs were 9.0, 9.2, and 9.3 years. The incremental cost per QALY for hybrid compared with cemented prostheses was £2500. If the threshold willingness to pay for a QALY gain exceeded £10 000, the probability that hybrid prostheses were most cost effective was about 70%. Hybrid prostheses have the highest probability of being the most cost effective in all subgroups, except in women aged 80, where cemented prostheses were most cost effective.

Conclusions: Cemented prostheses were the least costly type for total hip replacement, but for most patient groups hybrid prostheses were the most cost effective. Cementless prostheses did not provide sufficient improvement in health outcomes to justify their additional costs.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Markov model for cost effectiveness analysis of alternative prostheses types for primary total hip replacement
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Fig 2 Cost effectiveness acceptability curves for cemented, cementless, and hybrid prostheses for total hip replacement by subgroup plotted for alternative threshold willingness to pay for a quality adjusted life year (QALY) gained
See this image and copyright information in PMC

Comment in

References

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    1. National Joint Registry for England and Wales. National joint registry, 8th annual report. NJR, 2011.
    1. Hip and knee replacements in Canada—Canadian Joint replacement Registry (CJRR) 2008-2009 annual report. Canadian Institute for Health Information, 2009.
    1. Graves S, Davidson D, de Steiger R, Tomkins A, Ryan P, Griffith L, et al. Australian Orthopaedic Association National Joint Replacement Registry. Annual report. AOA, 2011.
    1. Mendenhall S. Hip and knee implant review. Orthopedic News Network 2004;14:1-16.

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