The Cost-Effectiveness of Total Hip Arthroplasty in Patients 80 Years of Age and Older

• Published in: The Journal of arthroplasty 2018-05, Vol.33 (5), p.1359-1367
• Main Authors: Kunkel, Samuel T., Sabatino, Matthew J., Kang, Ravinder, Jevsevar, David S., Moschetti, Wayne E.
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Arthroplasty, Replacement, Hip - economics; Cohort Studies; Cost-Benefit Analysis; cost-effectiveness; elderly; hip replacement; Humans; Markov Chains; octogenarian; Osteoarthritis, Hip - economics; Osteoarthritis, Hip - surgery; Postoperative Period; Probability; Quality-Adjusted Life Years; Risk; Sensitivity and Specificity; total hip arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.11.063

This study investigates the cost-effectiveness of total hip arthroplasty (THA) in patients 80 years old. A Markov, state-transition model projecting lifetime costs and quality-adjusted life years (QALYs) was constructed to determine cost-effectiveness from a societal perspective. Costs (in 2016 US dollars), health state utilities, and state transition probabilities were obtained from published literature. Primary outcome was incremental cost-effectiveness ratio, with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to evaluate parameter assumptions. At our base-case values, THA was cost-effective compared to non-operative treatment with a total lifetime accrued cost of $186,444 vs $182,732, and a higher lifetime accrued utility (5.60 vs 5.09). Cost per QALY for THA was $33,318 vs $35,914 for non-operative management, and the incremental cost-effectiveness ratio was $7307 per QALY. Sensitivity analysis demonstrated THA to be cost-effective with a utility of successful primary THA above 0.67, a peri-operative mortality risk below 0.14, and a risk of primary THA failure below 0.14. Analysis further demonstrated that THA is a cost-effective option below a base-rate mortality threshold of 0.19, corresponding to the average base-rate mortality of a 93-year-old individual. Markov cohort analysis indicated that for patients undergoing THA at age 80 there was an approximate 28% reduction in total lifetime long-term assisted living expenditure compared to non-operatively managed patients with end-stage hip osteoarthritis. The results of our model demonstrate that THA is a cost-effective option compared to non-operative management in patients ≥80 years old. This analysis may inform policy regarding THA in elderly patients.