Delaying Hip Replacement Not Cost-Effective Says Report

In short

Medtech industry body Eucomed has issued a press release that might have the effect of supporting its members efforts. The release talks of a report which has found that delaying Total Hip Replacement surgery (THR) in people with osteoarthritis (OA) as a way to cut costs is ineffective and denies patients the benefits of an active and healthy life.

Background

The findings have been published in Value in Health and demonstrated the cost-effectiveness of early total hip replacement. The original research was undertaken by the European Health Technology Institute for Socio-Economic Research (EHTI) into the budget implication for the Italian National Health Service of early access versus delayed THR.

The study “Cost-Effectiveness Analysis of Early versus Late Total Hip Replacement in Italy” is the first study evaluating the cost-effectiveness of delaying Total Hip Replacement. Three options for treating functionally independent patients with severe osteoarthritis were assessed: Immediate primary THR; Non-surgical therapy followed by primary THR upon disease progression to a functionally dependent state and finally drug treatment.

While the Eucomed release doesn’t provide details of the findings, it does cover the conclusion, which is that there is no net cost saving by delaying THR.  A quick squizz at the original research, though, suggests that at age 65 years, the incremental cost per quality-adjusted life-year of THR over delayed THR was €987 in men and €466 in women. The figures for delayed THR versus medical therapy were €463 and €82, respectively. The abstract can be found here.

Also, young adults do not benefit from postponing the treatment to avoid revision surgery in later life as the majority of younger people will never have to undergo revision surgery with current technology.

Investigator comments 

Ruben Mujica-Mota, the lead researcher and Senior Lecturer Health Economics at the University of Exeter commented on the study: “This research clearly suggests that the cost savings to national health systems in Europe brought about by delaying THR may not justify the large quality of life losses to patients.”

“The outcome of the model indicates that a healthcare strategy delaying intervention of THR in patients with severe osteoarthritis has limited value in reducing the total cost of treatment. On the contrary, a strategy of not postponing total hip replacement surgery provides a significant benefit to patients”, said Yves Verboven, Executive Director EHTI.

“It is encouraging to see that for patients with osteoarthritis early access to current total hip replacements can be offered cost-effectively. We look forward to the results of on-going research into the socio-economic benefit and implications on retirement age of total hip replacements,” Renaat Vermeulen, Industry representative on the EHTI Board commented on the findings

Source: Eucomed