Cost-effectiveness of implant movement analysis in aseptic loosening after hip replacement: a health-economic model

• Published in: Cost effectiveness and resource allocation 2023-11, Vol.21 (1), p.1-88, Article 88
• Main Authors: Lovera, Davide, Sandberg, Olof, Mohaddes, Maziar, Gyllensten, Hanna
• Format: Article
• Language: English
• Subjects: Arthroplasty; Comparative analysis; Cost analysis; Cost and cost analysis; Cost benefit analysis; Cost-effectiveness analysis; Decision making; Decision trees; Economic aspects; Economic models; Economics; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Fractures; Health Care Service and Management, Health Policy and Services and Health Economy; Hip joint; Hip/adverse effects; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Joint surgery; Kirurgi; Medical imaging; Patients; Public Health, Global Health, Social Medicine and Epidemiology; Questionnaires; Reoperation; Replacement; Resource allocation; Sensitivity analysis; Surgeons; Surgery; Transplants & implants; X-Ray computed; X-rays
• ISSN: 1478-7547; 1478-7547
• DOI: 10.1186/s12962-023-00498-w

Objective To investigate the cost-effectiveness of using Implant Movement Analysis (IMA) to follow up suspected aseptic loosening when the diagnosis after an initial X-ray is not conclusive, compared with a diagnostic pathway with X-ray follow-up. Methods A health-economic model in the form of a decision tree was developed using quality-adjusted life years (QALY) from the literature, cost-per-patient data from a university hospital and the probabilities of different events from expert physicians' opinions. The base case incremental cost-effectiveness ratio (ICER) was compared with established willingness-to-pay thresholds and sensitivity analyses were performed to account for assumptions and uncertainty. Results The base case ICER indicated that the IMA pathway was cost effective (SEK 99,681, compared with the SEK 500,000 threshold). In the sensitivity analysis, the IMA pathway remained cost effective during most changes in parameters. ICERs above the threshold value occurred in cases where a larger or smaller proportion of people receive immediate surgery. Conclusion A diagnostic pathway using IMA after an inconclusive X-ray for suspected aseptic loosening was cost effective compared with a pathway with X-ray follow-up. Keywords: Cost-effectiveness analysis, Cost and cost analysis, Arthroplasty, Replacement, Hip/adverse effects, Reoperation, Tomography, X-Ray computed