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. 2023 Nov 20;21(1):88.
doi: 10.1186/s12962-023-00498-w.

Cost-effectiveness of implant movement analysis in aseptic loosening after hip replacement: a health-economic model

Davide Lovera  1   2 , Olof Sandberg  2 , Maziar Mohaddes  3 , Hanna Gyllensten  4
Affiliations

Cost-effectiveness of implant movement analysis in aseptic loosening after hip replacement: a health-economic model

Davide Lovera et al. Cost Eff Resour Alloc. .

Abstract

Objective: To investigate the cost-effectiveness of using Implant Movement Analysis (IMA) to follow up suspected aseptic loosening when the diagnosis after an initial X-ray is not conclusive, compared with a diagnostic pathway with X-ray follow-up.

Methods: A health-economic model in the form of a decision tree was developed using quality-adjusted life years (QALY) from the literature, cost-per-patient data from a university hospital and the probabilities of different events from expert physicians' opinions. The base case incremental cost-effectiveness ratio (ICER) was compared with established willingness-to-pay thresholds and sensitivity analyses were performed to account for assumptions and uncertainty.

Results: The base case ICER indicated that the IMA pathway was cost effective (SEK 99,681, compared with the SEK 500,000 threshold). In the sensitivity analysis, the IMA pathway remained cost effective during most changes in parameters. ICERs above the threshold value occurred in cases where a larger or smaller proportion of people receive immediate surgery.

Conclusion: A diagnostic pathway using IMA after an inconclusive X-ray for suspected aseptic loosening was cost effective compared with a pathway with X-ray follow-up.

Keywords: Arthroplasty; Cost and cost analysis; Cost-effectiveness analysis; Hip/adverse effects; Reoperation; Replacement; Tomography; X-Ray computed.

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Conflict of interest statement

OS is a full-time employee at Sectra AB, a company commercializing a diagnostic tool for implant loosening diagnosis. DL has worked as a health economist for the aforementioned company. MM and HG declare no conflicts.

Figures

Fig. 1
Fig. 1
Decision trees depicting the standard diagnostic pathway for patients diagnosed with aseptic loosening. A Basic model and B IMA diagnostic pathway. A The model assumes no uncertainty in the results from an initial X-ray for patients with suspected aseptic loosening. B The model includes a group of patients for whom the initial X-ray did not provide conclusive information about aseptic loosening
Fig. 2
Fig. 2
Cost-effectiveness planes produced from; A the probabilistic sensitivity analysis and B deterministic sensitivity analysis. WTP: Willingness to pay, SEK: Swedish krona, QALYs: Adjusted Quality Life Years, AL: Aseptic loosening, BM: Base model, AM: Alternative model, SEK: Swedish krona
Fig. 3
Fig. 3
Tornado diagram based on the sensitivity analysis made on the QALYs for the IMA pathway. IMA: Implant Movement Analysis, QALYs: Quality Adjusted Life Years
Fig. 4
Fig. 4
Tornado diagram based on the sensitivity analysis made on the costs for the IMA pathway. CT: Computed Tomography, IMA: Implant Movement Analysis, BT: Bootstrapped, BC: Bias-corrected, Min: Minimum, Max: Maximum, CI: Confidence Interval
See this image and copyright information in PMC

References

    1. Knight SR, Aujla R, Biswas SP. Total hip arthroplasty: over 100 years of operative history. Orthop Rev. 2011;3(2):e16. doi: 10.4081/or.2011.e16. - DOI - PMC - PubMed
    1. Varacallo M, Luo TD, Johanson NA. Total hip arthroplasty techniques. In: StatPearls. StatPearls Publishing; 2023. http://www.ncbi.nlm.nih.gov/books/NBK507864/. Accessed 30 Oct 2023. - PubMed
    1. Maradit Kremers H, Larson DR, Crowson CS, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am. 2015;97(17):1386–1397. doi: 10.2106/JBJS.N.01141. - DOI - PMC - PubMed
    1. Rosengren BE, Karlsson MK. The annual number of hip fractures in Sweden will double from year 2002 to 2050: projections based on local and nationwide data. Acta Orthop. 2014;85:234–237. doi: 10.3109/17453674.2014.916491. - DOI - PMC - PubMed
    1. Sadoghi P, Liebensteiner M, Agreiter M. Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty. 2013;28:1329–1332. doi: 10.1016/j.arth.2013.01.012. - DOI - PubMed