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Choice of Prosthetic Implant Combinations in Total Hip Replacement: Cost-Effectiveness Analysis Using UK and Swedish Hip Joint Registries Data

Journal article
Authors C. G. Fawsitt
H. H. Z. Thom
L. P. Hunt
Szilard Nemes
A. W. Blom
N. J. Welton
W. Hollingworth
J. A. Lopez-Lopez
A. D. Beswick
A. Burston
Ola Rolfson
Göran Garellick
E. M. R. Marques
Published in Value in Health
Volume 22
Issue 3
Pages 303-312
ISSN 1098-3015
Publication year 2019
Published at Institute of Clinical Sciences, Department of Orthopaedics
Pages 303-312
Language en
Keywords combinations, cost-effectiveness, prosthetic hip implant, total hip replacement, bearing surfaces, knee replacement, arthroplasty, osteoarthritis, survivorship, England
Subject categories Health Care Service and Management, Health Policy and Services and Health Economy, Orthopedics


Background: Prosthetic implants used in total hip replacements (THR) have a range of bearing surface combinations (metal-onpolyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, and metal-on-metal), head sizes (small [<36 mm in diameter] and large [>= 36 mm in diameter]), and fixation techniques (cemented, uncemented, hybrid, and reverse hybrid). These can influence prosthesis survival, patients' quality of life, and healthcare costs. Objectives: To compare the lifetime cost-effectiveness of implants for patients of different age and sex profiles. Methods: We developed a Markov model to compare the cost-effectiveness of various implants against small-head cemented metal-on-polyethylene implants. The probability that patients required 1 or more revision surgeries was estimated from analyses of more than 1 million patients in the UK and Swedish hip joint registries, for men and women younger than 55, 55 to 64, 65 to 74, 75 to 84, and 85 years and older. Implant and healthcare costs were estimated from local procurement prices, national tariffs, and the literature. Quality-adjusted life-years were calculated using published utility estimates for patients undergoing THR in the United Kingdom. Results: Small-head cemented metal-on-polyethylene implants were the most cost-effective for men and women older than 65 years. These findings were robust to sensitivity analyses. Small-head cemented ceramic-on-polyethylene implants were most cost-effective in men and women younger than 65 years, but these results were more uncertain. Conclusions: The older the patient group, the more likely that the cheapest implants, small-head cemented metal-on-polyethylene implants, were cost-effective. We found no evidence that uncemented, hybrid, or reverse hybrid implants were the most cost-effective option for any patient group. Our findings can influence clinical practice and procurement decisions for healthcare payers worldwide.

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