Modeling the Cost-Effectiveness for Cement-Less and Hybrid Prosthesis in Total Hip Replacement in Emilia Romagna, Italy

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• 作者：Gian Luca Di Tanna M.Phil. ; M.Sc.^* ; ^† ; ; ^{gianluca.ditanna@uniroma1.it"" rel=""nofollow} ; Salvatore Ferro M.D.^‡ ; ; Filippo Cipriani Ph.D.^† ; ; Barbara Bordini MAS^§ ; ; Susanna Stea Ph.D.^§ ; ; Aldo Toni M.D.^§ ; ; Federico Silipo Ph.D. ; Giampiero Pirini Ph.D. ; Roberto Grilli M.D.^*
• 关键词：total hip replacement ; cost effectiveness analysis ; Markov model ; sensitivity analysis ; economic evaluation
• 刊名：Journal of Surgical Research
• 出版年：2011
• 出版时间：August 2011
• 年：2011
• 卷：169
• 期：2
• 页码：227-233
• 全文大小：231 K

文摘

Background

The aim of the present study was to assess the cost-effectiveness of cement-less versus hybrid prostheses in total hip replacement (THR) in patients diagnosed with primary osteoarthritis.

Methods

Effectiveness data were obtained from the Emilia-Romagna Regional Registry on Orthopaedic Prosthesis (RIPO), which collects information on all orthopaedic intervention performed in Emilia-Romagna (41,199 total hip replacements performed from 2000 to 2007), and from which we obtained survival curves and transition probabilities for the cement-less and hybrid prostheses, respectively. Conversely, costs were derived from regional databases through a specific procedure, which allowed us to register individual component's costs for both primary and subsequent revision interventions. A specific Markov transition model was constructed in order to consider the 3 types of revisions that an implant could possibly undergo through its life-span: total, cup or stem, head insert or neck. The cost-effectiveness was expressed in terms of cost per “revision-free” life year.

Results and conclusions

Considering a 70-y old patient undergoing THR, the cementless strategy resulted more effective but more costly than the hybrid solution, with an incremental cost effectiveness ratio of 2401.63 € per revision-free life year. Following a deterministic sensitivity analysis, hybrid and cementless fixation showed, respectively, a dominance profile for patients older than 83 y and younger than 43 y, whereas for all ages in between, we report a progressive increase in the ICER of cementless prostheses. Our results proved to be robust, as underlined by the probabilistic sensitivity analysis performed using cost distributions.