Open AccessThe use of patient-reported outcome measures to guide referral for hip and knee arthroplasty
Author(s) -
Helen Dakin,
Peter Eibich,
David Beard,
Alastair Gray,
Andrew Price
Publication year - 2020
Publication title -
the bone and joint journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.587
H-Index - 181
eISSN - 2049-4408
pISSN - 2049-4394
DOI - 10.1302/0301-620x.102b7.bjj-2019-0105.r2
Subject(s) - medicine , arthroplasty , oxford knee score , referral , physical therapy , quality of life (healthcare) , total knee arthroplasty , osteoarthritis , surgery , alternative medicine , nursing , family medicine , pathology
Aims To assess how the cost-effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) varies with age, sex, and preoperative Oxford Hip or Knee Score (OHS/OKS); and to identify the patient groups for whom THA/TKA is cost-effective.Methods We conducted a cost-effectiveness analysis using a Markov model from a United Kingdom NHS perspective, informed by published analyses of patient-level data. We assessed the cost-effectiveness of THA and TKA in adults with hip or knee osteoarthritis compared with having no arthroplasty surgery during the ten-year time horizon.Results THA and TKA cost < £7,000 per quality-adjusted life-year (QALY) gained at all preoperative scores below the absolute referral thresholds calculated previously (40 for OHS and 41 for OKS). Furthermore, THA cost < £20,000/QALY for patients with OHS of ≤ 45, while TKA 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.Conclusion If society is willing to pay £20,000 per QALY gained, THA and TKA are cost-effective for nearly all patients who currently undergo surgery, including all patients at and above our calculated absolute referral thresholds. Cite this article: Bone Joint J 2020;102-B(7):950–958.