Immediate surgery versus waiting list policy in revision total hip arthroplasty. An economic evaluation

An economic evaluation was carried out using a decision tree that models the costs and consequences of surgery at the point of consultation versus a waiting list policy for candidates in need of revision hip arthroplasty. The theoretical scenarios looked at a 2-year period wherein the immediate surgery patients incurred costs for 2 years after surgery, whereas the waiting list patients incurred costs for 1 year before and 1 year after surgery. Outcome probabilities were defined and applied to each treatment group, as derived from the literature and expert opinion. Expenditures were derived from the literature, based on conservative estimates of predicted pre- and postsurgical behavior for each scenario. This analysis indicates the potential for both substantial savings in resources and improved patient outcome for immediate surgery over waiting lists. These savings would begin at the inception of the immediate surgery protocol. Sensitivity analysis indicates that the conclusion is valid over a wide range of expenditures and probabilities.