Predicting the cost-effectiveness of total hip and knee replacement A HEALTH ECONOMIC ANALYSIS

University of Edinburgh, Department of Orthopaedics, Chancellor's Building, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SB, UK.
The Bone & Joint Journal (Impact Factor: 3.31). 01/2013; 95-B(1):115-21. DOI: 10.1302/0301-620X.95B1.29835
Source: PubMed


The aim of this study was to perform a cost-utility analysis of total hip (THR) and knee replacement (TKR). Arthritis is a disabling condition that leads to long-term deterioration in quality of life. Total joint replacement, despite being one of the greatest advances in medicine of the modern era, has recently come under scrutiny. The National Health Service (NHS) has competing demands, and resource allocation is challenging in times of economic restraint. Patients who underwent THR (n = 348) or TKR (n = 323) between January and July 2010 in one Scottish region were entered into a prospective arthroplasty database. A health-utility score was derived from the EuroQol (EQ-5D) score pre-operatively and at one year, and was combined with individual life expectancy to derive the quality-adjusted life years (QALYs) gained. Two-way analysis of variance was used to compare QALYs gained between procedures, while controlling for baseline differences. The number of QALYs gained was higher after THR than after TKR (6.5 vs 4.0 years, p < 0.001). The cost per QALY for THR was £1372 compared with £2101 for TKR. The predictors of an increase in QALYs gained were poorer health before surgery (p < 0.001) and younger age (p < 0.001). General health (EQ-5D VAS) showed greater improvement after THR than after TKR (p < 0.001). This study provides up-to-date cost-effectiveness data for total joint replacement. THR and TKR are extremely effective both clinically and in terms of cost effectiveness, with costs that compare favourably to those of other medical interventions.Cite this article: Bone Joint J 2013;95-B:115-21.

1 Follower
37 Reads
  • Source
    • "Knee replacement surgery is among the most common and successful surgical procedures, providing relief of pain and restoration of function to the majority of recipients [1]. Unicompartmental knee replacement (UKR) offers effective treatment for isolated medial compartment knee osteoarthritis with ten year survival rates of 96% reported [2]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study investigated the effect of socioeconomic deprivation on preoperative disease and outcome following unicompartmental knee replacement (UKR). 307 Oxford UKRs implanted between 2008 and 2013 under the care of one surgeon using the same surgical technique were analysed. Deprivation was quantified using the Northern Ireland Multiple Deprivation Measure. Preoperative disease severity and postoperative outcome were measured using the Oxford Knee Score (OKS). There was no difference in preoperative OKS between deprivation groups. Preoperative knee range of motion (ROM) was significantly reduced in more deprived patients with 10° less ROM than least deprived patients. Postoperatively there was no difference in OKS improvement between deprivation groups (p=0.46), with improvements of 19.5 and 21.0 units in the most and least deprived groups respectively. There was no significant association between deprivation and OKS improvement on unadjusted or adjusted analysis. Preoperative OKS, Short Form 12 mental component score and length of stay were significant independent predictors of OKS improvement. A significantly lower proportion of the most deprived group (15%) reported being able to walk an unlimited distance compared to the least deprived group (41%) one year postoperatively. More deprived patients can achieve similar improvements in OKS to less deprived patients following UKR. 2b - retrospective cohort study of prognosis. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Aug 2015 · The Knee
  • [Show abstract] [Hide abstract]
    ABSTRACT: The number of arthroplasties is rapidly increasing, however most materials used for such applications lack in osseointegration. The improvement of the bone/implant interface has received great attention for many years, with special reference to titanium-based implants. The interface between bone and implant has been considered both by physical approaches focused on surface topography and by chemical/biochemical surface modification by incorporation of organic molecules. The work described here is focused on the fabrication of implant coatings by layer by layer self-assembly of Collagen I (COL) and Hyaluronic acid (HA). The multilayer structure has been characterized by SEM and AFM, and the Titanium substrates coated with this multilayers have been tested with 3T3 cells seeded on Titanium supports. The results show that these coatings are promising for the improvement of implant osseointegration. This fabrication method is easily reproducible, versatile and economic.
    No preview · Conference Paper · Jan 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Knee replacement is one of the commonest surgical procedures performed in older adults, and its incidence is increasing rapidly. It is the only curative procedure for knee osteoarthritis, and it has excellent outcomes overall in terms of reoperation, functional outcomes and cost-effectiveness. However, a significant proportion of patients are dissatisfied after knee replacement surgery and there is a growing body of research into predictors of poor outcome and dissatisfaction.In this review, we discuss the place of total knee replacement (TKR) in the management of osteoarthritis, together with operative and non-operative alternatives to TKR. We discuss the different ways in which outcome can be measured, and the influence of patient and surgical factors on the success or failure of knee replacement surgery.
    No preview · Article · Apr 2013 · Maturitas
Show more