Cost-effectiveness analysis of periacetabular osteotomy.

Abstract

BACKGROUND:

A lack of long-term outcomes data following periacetabular osteotomy makes it difficult for surgeons to recommend the most appropriate procedure to young patients who might be candidates for a joint-preserving procedure. In this study, we compared the cost-effectiveness of periacetabular osteotomy with total hip arthroplasty in terms of cost per quality-adjusted life year for the young adult.

METHODS:

A decision model was constructed for a cost-utility analysis of periacetabular osteotomy compared with total hip arthroplasty. Outcome probabilities and effectiveness were derived from the literature. Effectiveness was expressed in quality-adjusted life years gained. Cost data were compiled and verified from our institution. Costs and utilities were discounted in accord with the United States Panel on Cost-Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and net health benefits. Multivariate sensitivity analysis was used to assess the contribution of included variables in the model's outcomes.

RESULTS:

For Tönnis grade-1 coxarthrosis, periacetabular osteotomy dominates with an average incremental cost-effectiveness of $7856 per quality-adjusted life year and an average incremental effectiveness of 0.15. For Tönnis grade-2 coxarthrosis, periacetabular osteotomy is, on the average, more cost-effective than total hip arthroplasty with an incremental cost-effectiveness of $824 per quality-adjusted life year, but it is less effective than total hip arthroplasty, on the average, with an incremental effectiveness of -1.4 quality-adjusted life years. Periacetabular osteotomy becomes more cost-effective at a longevity of 5.5 years for Tönnis grade-1 coxarthrosis and 18.25 years for Tönnis grade-2 coxarthrosis. In Tönnis grade-3 coxarthrosis, total hip replacement becomes the dominant treatment strategy.

CONCLUSIONS:

Periacetabular osteotomy is, on the average, more cost-effective in Tönnis grade-1 and grade-2 coxarthrosis, while it is both more costly and less effective in Tönnis grade-3 coxarthrosis. These findings can inform clinical decision-making in the absence of long-term data. On the basis of this model, periacetabular osteotomy is preferable to total hip arthroplasty in Tönnis grade-1 and grade-2 coxarthrosis when the patient is sufficiently young and when functionality in sports is important.

• Authors: Emile Sharifi, Husham Sharifi, Saam Morshed, Kevin Bozic, Mohammad Diab
• Journal: The Journal of bone and joint surgery. American volume (J Bone Joint Surg Am) Vol. 90 Issue 7 Pg. 1447-56 (Jul 2008) ISSN: 1535-1386 [Electronic] United States
• PMID: 18594092 (Publication Type: Comparative Study, Journal Article)

Topics

• Acetabulum (surgery)
• Adolescent
• Adult
• Age Factors
• Arthroplasty, Replacement, Hip (economics)
• Cost-Benefit Analysis
• Decision Support Techniques
• Hip Dislocation, Congenital (complications, surgery)
• Humans
• Middle Aged
• Osteoarthritis, Hip (etiology, surgery)
• Osteotomy (economics, methods)
• Quality of Life