The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study
- 1Norwich Medical School, University of East Anglia, Norwich, UK
- 2Norfolk and Norwich University Hospital, Norfolk, England, UK
- Correspondence to Dr Richard Fordham;
- Received 16 January 2012
- Accepted 19 April 2012
- Published 25 May 2012
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.
To cite: Fordham R, Skinner J, Wang X, et al. The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study. BMJ Open 2012;2:e000752. doi:10.1136/bmjopen-2011-000752
Contributors RF designed the conception, economic evaluation, led the analysis and wrote the first and subsequent drafts. JS undertook all the statistical processing and analysis and worked with RF and JN on the interpretation of results. XW helped revise the paper for publication. JN provided clinical input to the study throughout. JN as representative of Exeter Primary Outcomes Study (EPOS) provided approval of this paper along with other members of the EPOS Team.
Funding Stryker UK Ltd.
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.
Ethics approval Ethics approval was provided by EPOS.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Requests for data sharing need to be submitted to the Exeter Primary Outcomes Study Group coordinator initially.
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