Session Type: Abstract Submissions (ACR)
Background/Purpose: Utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) has nearly doubled in the last decade. These procedures are increasingly performed in younger, more active individuals. We sought to summarize the state of the literature evaluating the cost-effectiveness of these highly efficacious, costly procedures and identify areas where further work is needed.
Methods: We conducted a systematic review of cost-effectiveness analyses of elective THA and TKA that were published between January 1980 and February 2012. To limit our search to high-quality publications, we selected among papers included in the Cost-Effectiveness Analysis Registry (created by the Center for the Evaluation of Value and Risk in Health); we augmented our search with papers listed in PubMed. Only papers reporting incremental cost-effectiveness ratios (ICERs) as the change in cost over the change in quality-adjusted life expectancy between alternative treatment strategies were included. We abstracted the analysis perspective, time horizon, and ICERs (converted to 2011 USD) from the selected papers.
Results: Seven TKA and six THA studies met the criteria for our review. All economic evaluations of TKA were published between 2006 and 2012, whereas THA studies spanned 1996 to 2008. Out of the 13 included studies, four assumed the societal perspective, eight the payer perspective, and in one study the perspective was unclear. Seven studies spanned the lifetime horizon. Studies of both THA and TKA that have assumed a societal perspective and lifetime horizon have estimated ICERs below $50,000/QALY in cohorts with mean age 69 years or older. Hip resurfacing has been shown to be dominated by THA (more costly, less effective) in a cohort aged 65 years and younger. Unicondylar knee arthroplasty (UKA) has been shown to be cost effective or cost-saving among cohorts of mean age 65 – 75 years.
Conclusion: THA and TKA have been found to be highly cost-effective in a number of high-quality studies. Further analyses of the cost-effectiveness of alternative surgical options, including knee osteotomy, among young individuals are needed. Future economic evaluations should address the expanding indications of THA and TKA to younger, more physically active individuals.