Unsuspected Malignancies in Routine Femoral Head Histopathologic Examination During Primary Total Hip Arthroplasty: Cost-Effectiveness Analysis

• Published in: The Journal of arthroplasty Vol. 32; no. 3; pp. 735 - 742
• Main Authors: Liow, Ming Han Lincoln, Agrawal, Kshitijkumar, Anderson, David W., Freiberg, Andrew A., Rubash, Harry E., Kwon, Young-Min
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Bone Marrow Neoplasms - diagnosis; Bone Marrow Neoplasms - economics; Bone Neoplasms - diagnosis; Bone Neoplasms - economics; Cost-Benefit Analysis; cost-effectiveness; Female; femoral head; Femur Head - pathology; Humans; incremental cost-utility ratio (ICUR); Male; Mass Screening - economics; Middle Aged; Neoplasms; Quality-Adjusted Life Years; Retrospective Studies; routine histopathologic examination; screening modality; Young Adult; screening modality; femoral head; cost-effectiveness; incremental cost-utility ratio (ICUR); routine histopathologic examination
• DOI: 10.1016/j.arth.2016.08.017
• ISSN: 0883-5403

Routine femoral head histopathology during primary total hip arthroplasty (THA) has been recently reported as a potentially useful screening tool for bone- and bone marrow–associated malignancies. However, cost-effectiveness of routine histopathology during THA remains unclear due to low prevalence of significant medical findings which alter patient management. The aim of this study was to evaluate the cost-effectiveness of routine histopathology in diagnosing unsuspected malignancy in patients undergoing primary THA. From 1993 to 2011, we retrospectively analyzed routine histopathologic findings of 3200 femoral head specimens from 2725 patients that underwent primary THA. Preoperative and postoperative diagnoses were classified into concordant (clinical diagnosis concurred with pathologic diagnosis), discrepant (differing diagnosis with no resultant impact on patient management), and discordant (differing diagnosis with subsequent change in patient management). Cost-effectiveness analysis was performed using the incremental cost-utility ratio. A total of 3055 of 3200 pathologic samples were concordant with the preoperative diagnosis (95.4%), 140 of 3200 were discrepant (4.4%), and 5 of 3200 were discordant (0.2%). Routine histopathology revealed 1 unsuspected malignancy out of 640 (5 of 3200) femoral heads. The total cost of histopathologic screening was $614,664.80. The average cost to identify a discrepant case was $4390.46, and the cost to identify a discordant case was $122,932.96. The incremental cost-utility ratio was $49,569.74 per quality-adjusted life year (QALY) gained. Our study indicates routine femoral head histopathology may be cost-effective in diagnosing unsuspected malignancy at $49,569.74/QALY gained (less than World Health Organization recommended threshold $159,000/QALY gained), providing useful clinical information for surgeons considering the value of routine femoral head histopathology in patients undergoing THA.