Abstract | BACKGROUND: METHODOLOGY/PRINCIPAL FINDINGS: We performed a cost-utility analysis using a well-established multi-state semi-Markov model from an NHS and personal and social services perspective. We used individual patient data (IPD) from the National Joint Registry (NJR) for England and Wales on RS and THR surgery for osteoarthritis recorded from April 2003 to December 2012. We used flexible parametric modelling of NJR RS data to guide identification of patient subgroups and RS devices which delivered revision rates within the NICE 5% revision rate benchmark at 10 years. RS procedures overall have an estimated revision rate of 13% at 10 years, compared to <4% for most THR devices. New NICE guidance now recommends a revision rate benchmark of <5% at 10 years. 60% of RS implants in men and 2% in women were predicted to be within the revision benchmark. RS devices satisfying the 5% benchmark were unlikely to be cost-effective compared to THR at a standard UK willingness to pay of £20,000 per quality-adjusted life-year. However, the probability of cost effectiveness was sensitive to small changes in the costs of devices or in quality of life or revision rate estimates. CONCLUSION/SIGNIFICANCE: Our results imply that in most cases RS has not been a cost-effective resource and should probably not be adopted by decision makers concerned with the cost effectiveness of hip replacement, or by patients concerned about the likelihood of revision, regardless of patient age or gender.
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Authors | Ruth Pulikottil-Jacob, Martin Connock, Ngianga-Bakwin Kandala, Hema Mistry, Amy Grove, Karoline Freeman, Matthew Costa, Paul Sutcliffe, Aileen Clarke |
Journal | PloS one
(PLoS One)
Vol. 11
Issue 11
Pg. e0165021
( 2016)
ISSN: 1932-6203 [Electronic] United States |
PMID | 27802289
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adult
- Aged
- Arthroplasty, Replacement, Hip
(economics, methods)
- Cost-Benefit Analysis
(economics)
- England
- Female
- Health Personnel
(economics)
- Hip Prosthesis
(economics)
- Humans
- Male
- Metal-on-Metal Joint Prostheses
(economics)
- Metals
- Middle Aged
- Osteoarthritis, Hip
(surgery, therapy)
- Prosthesis Design
(economics, methods)
- Prosthesis Failure
- Quality of Life
- Registries
- Risk Factors
- Wales
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