Journal Article

The use of patient-reported outcome measures to guide referral for hip and knee replacement: Part 2 – a cost-effectiveness analysis

Dakin, H. D., Eibich, P., Beard, D., Gray, A. M., Price, A. J.
The Bone & Joint Journal, 102-B:7, 941–949 (2020)


Aims: To assess how the cost-effectiveness of total hip replacement (THR) and total knee replacement (TKR) vary with age, sex and pre-operative Oxford Hip or Knee Score (OHS/OKS) and identify the patient groups for whom THR/TKR is cost-effective.
Methods: We conducted a cost-effectiveness analysis using a Markov model from a UK NHS perspective, informed by published analyses of patient-level data. We assessed the cost-effectiveness of THR and TKR in adults with hip or knee osteoarthritis compared with having no arthroplasty surgery during the 10-year time horizon.
Results: THR and TKR cost <£7,000 per quality-adjusted life-year (QALY) gained at all pre-operative scores below the absolute referral thresholds calculated previously (40 for OHS and 41 for OKS). Furthermore, THR cost <£20,000/QALY for patients with OHS of ≤45, while TKR was cost-effective for patients with OKS of ≤43, since the small improvements in quality of life outweighed the cost of surgery and any subsequent revisions. Probabilistic and one-way sensitivity analyses demonstrated that there is little uncertainty around the conclusions. 
Conclusions: If society is willing to pay £20,000 per QALY gained, THR and TKR are cost-effective for nearly all patients who currently undergo surgery, including all patients up to the absolute referral thresholds.

The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.