Decision aids for patients considering total joint replacement: a cost-effectiveness analysis alongside a randomised...

Area of Science:

• Health Economics
• Orthopedic Surgery
• Patient-Centered Care

Background:

• Shared decision-making (SDM) is crucial for patient-centered care, particularly for decisions regarding total joint arthroplasty (TJA).
• Patient decision aids can facilitate SDM but may involve initial costs.
• This study evaluated the health and economic impact of patient decision aids for TJA.

Purpose of the Study:

• To estimate the health and economic effects of using patient decision aids in patients considering TJA.
• To assess the cost-effectiveness of patient decision aids compared to usual care in the context of TJA.

Main Methods:

• A cost-effectiveness analysis was conducted using data from a randomized controlled trial with 343 patients over a 2-year follow-up.
• Patients were randomized to receive a patient decision aid or usual care.
• Quality-adjusted life-years (QALYs) were derived from the WOMAC and EQ-5D, and costs were calculated using self-reported resource use.

Main Results:

• The decision aid group incurred lower costs ($-560 per patient) and gained more QALYs (0.05 per patient) compared to the usual care group.
• The patient decision aid intervention was found to be dominant, indicating both cost savings and improved health outcomes.
• Statistical analysis included multiple imputation for missing data and bootstrapping for uncertainty estimation.

Conclusions:

• Patient decision aids are associated with reduced healthcare costs for TJA.
• The use of decision aids results in comparable health outcomes for patients undergoing TJA.
• Implementing patient decision aids supports cost-effective, patient-centered care in orthopedic surgery.