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  • Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study

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Rheumatology
Research
Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study
  1. Peter Eibich1,2,
  2. Helen A Dakin1,
  3. Andrew James Price3,
  4. David Beard3,
  5. Nigel K Arden3,4,
  6. Alastair M Gray1
  1. 1 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2 Max Planck Institute for Demographic Research, Rostock, Germany
  3. 3 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  4. 4 Faculty of Medicine, University of Southampton, Southampton, UK
  1. Correspondence to Dr Peter Eibich; eibich{at}demogr.mpg.de

Abstract

Objectives To assess how costs and quality of life (measured by EuroQoL-5 Dimensions (EQ-5D)) before and after total hip replacement (THR) and total knee replacement (TKR) vary with age, gender and preoperative Oxford hip score (OHS) and Oxford knee score (OKS).

Design Regression analyses using prospectively collected data from clinical trials, cohort studies and administrative data bases.

Setting UK secondary care.

Participants Men and women undergoing primary THR or TKR. The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years. The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years. The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year.

Outcome measures EQ-5D-3L quality of life before and after surgery, costs of primary arthroplasty, costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement.

Results Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile. The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10. However, postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44. In contrast, costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS. For example, costs of hospital readmissions within 12 months after primary THR/TKR were £740/£888 for patients at the 5th percentile compared with £314/£404 at the 95th percentile of the OHS/OKS distribution.

Conclusions Our findings suggest that costs and quality of life associated with total joint replacement vary systematically with preoperative symptoms measured by OHS/OKS.

  • hip replacement
  • knee replacement
  • costs
  • quality-of-life
  • oxford hip score
  • oxford knee score

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-019477

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    Footnotes

    • Contributors AJP, DB, HAD, AMG and NKA conceived, designed and conducted the ACHE study. PE, HAD and AMG designed and conducted the regression analysis reported in this manuscript. PE and HAD analysed the data. PE drafted the manuscript. All authors edited the manuscript for important intellectual content and approved the final version. The authors had full access to the data (including statistical reports and tables), can take responsibility for the integrity of the data and the accuracy of the data analysis and are responsible for submitting this paper.

    • Funding All authors received a grant from NIHR funding the current work. KAT was funded by the NIHR as an HTA (No. 95/10/01). COASt was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (reference number RP-PG-0407-10064). This study was conducted as part of the project ’Introducing Standardised And Evidence-Based Thresholds for Hip and Knee Replacement Surgery – The Arthroplasty Candidacy Help Engine (The ACHE Tool)', which was funded under the UK National Institute of Health Research (NIHR) Health Technologies Assessment (HTA) Programme (HTA 11/63/01). Visit the HTA programme website (www.hta.ac.uk) for further project information. The funder had no involvement in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

    • Disclaimer The views and opinions expressed in this paper are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS, NHS Digital or the Department of Health. The manuscript’s guarantor (PE) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

    • Competing interests HAD reports personal fees from Halyard Health, outside the submitted work. NKA reports grants from Bioiberica, personal fees from Bioventus, personal fees from ESCEO, personal fees from Flexion, personal fees from Freshfields Bruckhaus Deringer, personal fees from Merck, personal fees from Regeneron, outside the submitted work.

    • Patient consent Obtained.

    • Ethics approval No primary data was collected for this study, and therefore ethical approval was not required. The COASt study obtained ethical approval from Oxford research Ethics Committee (REC Ref: 10/H0604/91). The KAT trial was approved by the Multi Centre Research Ethics Committee for Scotland in November 1998 (research protocol MREC/98/0/100) and was approved by the Local Research Ethics Committees in each study centre recruiting trial participants.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data on NHS PROMs linked to HES APC data were reused with the permission of NHS Digital, copyright 2015, with all rights reserved. The statistical code as well as variance–covariance matrices for the analyses reported in this study are available from the authors on request. PROMs/HES data are available from NHS Digital (http://content.digital.nhs.uk/dars); enquiries about access to the KAT data should be directed to kat@abdn.ac.uk; enquiries about access to the COASt data should be directed to coast.study@ndorms.ox.ac.uk