Costs of elective total hip arthroplasty during the first year: Cemented versus noncemented

doi:10.1016/0883-5403(94)90093-0

The Journal of Arthroplasty

Volume 9, Issue 5, October 1994, Pages 481-487

https://doi.org/10.1016/0883-5403(94)90093-0 Get rights and content

Abstract

The cost-effectiveness of the Mallory Head (Biomet, Warsaw, IN) cemented versus noncemented total hip arthroplasty was determined as part of a randomized trial. Costs were assessed during the first postoperative year. In-hospital resource use was determined using a chart review of 60 randomly selected patients. Costs were determined using a fully allocated costing model. Outpatient resource use was determined using patient diaries, and appropriate costs were allocated for outpatient visits, admissions to hospital, and patient-borne costs. There was no difference in costs between the cemented and noncemented prostheses. The average cost of the initial hospitalization was $9,990 (1988 Canadian dollars), and outpatient costs during the first year were $1,137 (total cost during the first year was $11,127). The cost per quality adjusted life year was $27,139 during the first year and $8,031 during the first 3 years.

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Cited by (93)

Incidence of hip and knee prosthetic infections in a specialized center of Mexico City
2017, Cirugia y Cirujanos (English Edition)
Las artroplastias de cadera y rodilla han demostrado ser el tratamiento óptimo para las articulaciones que no se benefician de intervenciones médicas o artroscópicas; sin embargo, la infección de la prótesis articular es la complicación más temida. Se estima que la incidencia de las infecciones no debe exceder del 2%.
Se llevó a cabo un estudio observacional, longitudinal, prospectivo en pacientes tratados mediante prótesis articular de agosto de 2011 a julio de 2012. Se les realizó un seguimiento pre- y posquirúrgico anual para identificar un proceso infeccioso articular. Se reconocieron las infecciones de prótesis utilizando los estándares internacionales acostumbrados. Se calculó la incidencia de infecciones de prótesis, así como la densidad de incidencia.
Se incluyó a 339 pacientes (179 de cadera y 160 de rodilla). Se observaron alteraciones en la hora de aplicación de antibióticos preoperatorios. Se identificaron 6 infecciones protésicas, con una tasa de incidencia de 1.79/339 artroplastias, de 2.2/179 para cadera y de 1.25/160 para rodilla. Una densidad de incidencia de 0.02/año para cadera y de 0.11/año para rodilla. Hubo 4 infecciones de cadera y 2 de rodilla, 5 de ellas infecciones agudas y una crónica. Los microorganismos aislados fueron E. faecalis, S. epidermidis (2), S. mitis, S. aureus y P. stomatis.
La incidencia de infección de prótesis articular de cadera y rodilla en nuestro centro está dentro de los parámetros recomendados dentro del primer año de seguimiento. Las prácticas organizacionales y técnicas quirúrgicas influyen en los buenos resultados.
Hip and knee prosthetic replacements have proven to be the most appropriate treatment in the joints that do not benefit from medical or arthroscopic interventions; however, infections are the most feared complication. It is recommended that the incidence of infection should not exceed 2%.
This was an observational, prospective, longitudinal and observational study conducted in patients fitted with a prosthetic joint from August 2011 to July 2012. Patients were followed up pre and post-surgery for one year to identify a prosthetic infection, diagnosed using international parameters. We calculated the incidence of prosthetic infection, as well as the incidence density.
A total of 339 patients (179 hip and 160 knee) were included. Variations in the time of pre-operative antibiotics’ administration were observed. Six prosthetic infections were identified with an incidence rate of 1.79/339 arthroplasties, 2.2/179 hip procedures, and 1.25/160 knee arthroplasties. An incidence density of 0.02/year for hip arthroplasties and 0.11/year for knee procedures was identified. There were 4 infections of hip and 2 of knee. Five infections were acute and one chronic. The isolated microorganisms were E. faecalis, S. epidermidis (2), S. mitis, S. aureus and P. stomatis.
The incidence of prosthetic joint infection in the first year of follow-up at our centre is within the recommended parameters. Surgical techniques and organizational practices influence the results.
The Cost-Utility of Total Hip Arthroplasty: Earlier Intervention, Improved Economics
2015, Journal of Arthroplasty
Citation Excerpt :
This is in agreement with our hypothesis as the group with a worse preoperative joint disease state had the less valuable cost-effective intervention. In agreement with previous findings [6,10–12,20,24,25], we found that primary THA (even in patients with end-stage joint disease) is a cost-effective intervention and it is well below the $50,000 mark conveyed as the threshold defining a value purchase [24]. Interestingly, we found that a higher (worse) preoperative WOMAC score resulted in fewer gains on QALY and higher cost per QALY gained, which ultimately led to a less valuable cost-effective procedure.
We estimated the cost of Quality-Adjusted-Life-Years gained according to preoperative disease severity. We studied 159 primary unilateral THA, mean follow-up: 4 years. A median split of preoperative WOMAC scores was done to set apart a low (better) and a high (worse) score group. The groups with worse preoperative WOMAC were consistently associated with a less cost-effective intervention. The highest mean cost-effectiveness was achieved by patients with better WOMAC-total ($8256.32/QALY-gained). As patients aged, the cost-effectiveness of THA decreased. Patients 75 years of age or older and with worse scores had the least cost-effective interventions ($25,937.33/QALY-gained). THA remains a very cost-effective intervention even when performed in older “sicker” patients. Waiting for the patient to deteriorate will make the intervention more “expensive”.
Elective primary total hip arthroplasty in octogenarians. A case-control study
2013, Revista Espanola de Cirugia Ortopedica y Traumatologia
Valorar los resultados y eficacia de la artroplastia total de cadera (ATC) no cementada en octogenarios con coxartrosis.
Estudio de caso-control con emparejamiento 1:2. Selección consecutiva de 54 octogenarios (55 caderas) y 106 controles (110 caderas) con edad: 70-79 años. Seguimiento medio de 7 años (rango: 5-12). Antes de 5 años de seguimiento murieron uno y 4 pacientes respectivamente, siendo excluidos. Se realizó la valoración clínica mediante ASA, comorbilidades, escalas de Harris y Merle D’Aubigné, y valoración radiográfica de complicaciones y de mortalidad.
En ambas cohortes no hubo muertes perioperatorias, siendo similar la tasa de complicaciones médicas (p = 0,601) y la supervivencia (p = 0,360) que a 7 años fue del 89,8% en octogenarios y 95,3% en controles, no influyendo las variables preoperatorias. No hubo diferencias en los resultados funcionales postoperatorios (p = 0,761), pero los octogenarios tuvieron mayor incremento (p = 0,002) respecto al preoperatorio. En octogenarios hubo 2 fracturas intraoperatorias, 2 luxaciones y 2 vástagos inestables. En los controles, una infección profunda, una fractura periprotésica femoral, e inestabilidad en 2 cotilos y 4 vástagos. Las tasas de complicaciones asépticas, de necesidad de revisión y de supervivencia de la artroplastia (94% a 7 años) fueron similares en ambas cohortes.
El incremento en el estado de salud hace que los octogenarios dispongan de una expectativa de vida de al menos 10 años. El argumento de costes y una edad arbitraria no debe influir en la selección de candidatos a ATC no cementada.
La ATC no cementada se ha mostrado segura y efectiva en los octogenarios con coxartrosis. El notable incremento encontrado en los resultados funcionales justifica el continuar utilizándola en estos pacientes.
To evaluate the results and efficacy of cementless total hip arthroplasty (THA) in octogenarians with osteoarthritis.
Matched case-control study with ratio 1:2. Consecutive selection of 54 octogenarians (55 hips), and 106 control patients (110 hips) with age ranging from 70 to 79 years. Mean follow-up of 7 years (range: 5-12). Before 5 postoperative years, 1 and 4 patients, respectively, died and they were excluded. Clinical assessment was performed using ASA grade, comorbidities, and Harris and Merle D’Aubigné hip scores, and radiographic, complications, and mortality evaluations were made.
There were no perioperative deaths in either cohort. The rates of postoperative medical complications (P=.601) and survival (P=.360) were similar. The survival at 7 years was 89.8% in octogenarian and 95.3% in controls, with no influence of the preoperative variables. There were no differences in postoperative functional outcomes (P=.761), but improvement respect to the preoperative was higher in octogenarian (P=.002). In octogenarians there were 2 intraoperative fractures, 2 dislocations and 2 unstable stems, and in control patients 1 deep infection, 1 peri-prosthetic femoral fracture, 2 unstable cups and 4 unstable stems. The rates of aseptic complications, the need for revision, and arthroplasty survival (94% at 7 years) were similar in both cohorts.
Due to improvement in health status, the octogenarian may have a life expectancy of at least 10 years. The cost arguments and an arbitrary age should not influence the selection of candidates for cementless THA.
Cementless THA has been shown to be safe and effective in octogenarian patients with osteoarthritis. The notable increase found in functional outcomes justifies the continued use in these patients.
The cost-effectiveness of total joint arthroplasty: A systematic review of published literature
2012, Best Practice and Research: Clinical Rheumatology
Citation Excerpt :
Five TKA papers and 11 THA papers were excluded in the abstract screening because they primarily evaluated non-elective surgery, adverse event prevention or pre or postoperative care [18–29]. Three TKA and five THA papers were excluded in the paper screening step because they did not report true ICERs [30–36]. Of the remaining papers, six TKA and three THA papers reported true ICERs and moved on to the data abstraction step [37–45].
To summarise the state of the literature evaluating the cost-effectiveness of elective total hip and knee arthroplasty (THA and TKA).
We conducted a systematic review of published cost-effectiveness analyses of THA and TKA. To limit our search to high-quality published papers, we selected those papers included in the Cost-Effectiveness Analysis Registry (created by the Center for the Evaluation of Value and Risk in Health at Tufts University) and augmented the search with papers listed in PubMed. The data abstracted included incremental cost-effectiveness ratios, perspective of the analysis, time frame, sensitivity analyses conducted, and utility assessment. All cost-effectiveness ratios were converted to 2011 USD.
Seven studies presenting cost-effectiveness ratios for TKA and six studies for THA were included in our review. All economic evaluations of TKA were published between 2006 and 2012. By contrast, THA studies were published between 1996 and 2008. Out of the 13 studies evaluated in this review, four were from the societal perspective and eight were from the payer perspective. Five studies spanned the lifetime horizon. Of the selected studies, six used probabilistic sensitivity analysis to address uncertainty in data parameters. Both procedures have been shown to be highly cost-effective from the societal perspective over the entire lifespan.
THA and TKA have been found to be highly cost-effective in a number of high-quality studies. Further analyses are needed on the cost-effectiveness of alternative surgical options, particularly osteotomy. Future economic evaluations should address the expanding indications of THA and TKA to younger, more physically active individuals.
Quality of Life and Cost-Effectiveness 1 Year After Total Hip Arthroplasty
2011, Journal of Arthroplasty
Citation Excerpt :
This group concluded that total hip arthroplasty was cost-effective, but no specific dollar amount was published for cross comparison with other health interventions. The cost per QWY for primary total hip arthroplasty determined by Laupacis et al [22] was $27 139 during the first year and $8031 during the first 3 years (Canadian Dollars). Chang et al [33] published that a total hip arthroplasty in men aged 85 years or older cost society $80 000 dollars per QWY.
Quality of life index (Quality Of Well-Being [QWB]) was used to calculate the costs per quality of well year (QWY) in total hip arthroplasty (THA) and compare it to other interventions. Ninety-eight primary and/or revision THA were reviewed. Patients had minimum 1-year follow-up. Quality of life index was used to calculate the costs per QWY in primary and revision THA. Preoperative QWB for primary THA was 0.52 ± 0.06 SD; revision was 0.53 ± 0.07 SD. The QWB change at 1 year for primary THA was 0.08 ± 0.13 SD; revision THA was 0.06 ± 0.14 SD. Calculated costs per QWY were $5572 for primary procedures and $10 775 for revision procedures. Cost-effectiveness of THA compares favorably with other surgical and medical interventions such as epilepsy ablation surgery and gastric bypass surgery.
Value and cost in less invasive spinal fusion surgery: lessons from a community hospital
2010, SAS Journal

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Original articleCosts of elective total hip arthroplasty during the first year: Cemented versus noncemented

Abstract

J Health Economics

Cost-effectiveness of total joint arthroplasty in osteoarthritis

Arthritis Rheum

The relation of body weight to length of stay and charges for hospital services for patients undergoing elective surgery: a study of two procedures

Am J Public Health

Original article
Costs of elective total hip arthroplasty during the first year: Cemented versus noncemented