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Costs and cost-effectiveness in hip and knee replacements. A prospective study
P Rissanen1, S Aro, H Sintonen
1University of Kuopio.
Summary
Total hip (THA) and knee (TKA) replacements offer significant benefits, but their economics are less understood. This study found THA to be more cost-effective overall, with age significantly impacting TKA cost-effectiveness.
Area of Science:
- Orthopedic surgery
- Health economics
- Quality of life research
Background:
- The benefits of total hip (THA) and knee (TKA) arthroplasty are well-established, yet their economic implications, including cost-effectiveness, require further investigation.
- Understanding patient-related cost-effectiveness variances is crucial for optimizing resource allocation in joint replacement surgery.
Purpose of the Study:
- To assess the costs and cost-effectiveness (C/E) of THA and TKA.
- To analyze patient-related variances in C/E for these procedures.
- To evaluate the impact of patient characteristics, such as age, on the C/E of joint replacements.
Main Methods:
- A prospective study involving 276 THA and 176 TKA patients undergoing primary arthroplasty for arthrosis.
- Measurement of health and welfare service utilization and health-related quality of life (HRQoL) using 15D and Nottingham Health Profile pre-operatively and up to 24 months postoperatively.
- Cost assessment using patient questionnaires, Finnish Hospital Discharge Register, and Finnish Arthroplasty Register.
Main Results:
- Total hospital costs were approximately US $10,500 for THA and US $11,500 for TKA, with prosthesis costs accounting for 21-24%.
- THA patients generally experienced greater HRQoL gains and demonstrated better overall cost-effectiveness compared to TKA patients.
- Younger (< or = 60 years) TKA patients showed comparable C/E to all hip patients, while older TKA patients (> 60 years) had a worse C/E ratio than other subgroups.
Conclusions:
- THA appears more cost-effective than TKA on average, with significant variations influenced by patient age.
- Improving allocation efficiency in joint replacement surgery necessitates considering patient characteristics like age alongside the intervention itself.
- Age is a critical factor influencing the cost-effectiveness of TKA, more so than the difference between average THA and TKA procedures.