Use of cost-effectiveness analysis to evaluate new technologies in orthopaedics. The case of alternative bearing surfaces in total hip arthroplasty
Alternative bearing surfaces offer the potential to reduce wear and improve implant longevity following total hip arthroplasty. However, these technologies are associated with higher costs, the potential for unintended consequences, and uncertain benefits in terms of long-term survival of the implan...
Saved in:
Published in | Journal of bone and joint surgery. American volume Vol. 88; no. 4; p. 706 |
---|---|
Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.04.2006
|
Subjects | |
Online Access | Get more information |
Cover
Loading…
Abstract | Alternative bearing surfaces offer the potential to reduce wear and improve implant longevity following total hip arthroplasty. However, these technologies are associated with higher costs, the potential for unintended consequences, and uncertain benefits in terms of long-term survival of the implants. The purpose of this study was to evaluate the cost-effectiveness of the use of alternative bearings in total hip arthroplasty.
A decision-analysis model was constructed to estimate the cost-effectiveness of the use of alternative bearings for patients undergoing total hip arthroplasty. Model inputs, including costs, clinical outcome probabilities, and health utility values, were derived from a review of the literature. Sensitivity analyses were performed to evaluate the impact of patient age at the time of surgery, implant costs, and reductions in revision rates on the cost-effectiveness of alternate bearing surfaces.
In a population of fifty-year-old patients, use of an alternative bearing with an incremental cost of 2000 dollars would be cost-saving over the individual's lifetime if it were associated with at least a 19% reduction in the twenty-year implant failure rate when compared with the failure rate for a conventional bearing. In a population of patients over the age of sixty-three years, the same implant would be associated with higher lifetime costs than would a conventional bearing, regardless of the presumed reduction in the revision rate. Conversely, an alternative bearing that adds only 500 dollars to the cost of a conventional total hip arthroplasty could be cost-saving in a population of patients over the age of sixty-five years, even if it were associated with only a modest reduction in the revision rate. In a population of patients over the age of seventy-five years, no alternative bearing would be associated with lifetime cost-savings, regardless of the cost or the presumed reduction in the revision rate.
The cost-effectiveness of alternative bearings is highly dependent on the age of the patient at the time of surgery, the cost of the implant, and the associated reduction in the probability of revision relative to that associated with conventional bearings. Our findings provide a quantitative rationale for requiring greater evidence of effectiveness in reducing the probability of implant failure when more costly alternative bearings are being considered, particularly for older patients. |
---|---|
AbstractList | Alternative bearing surfaces offer the potential to reduce wear and improve implant longevity following total hip arthroplasty. However, these technologies are associated with higher costs, the potential for unintended consequences, and uncertain benefits in terms of long-term survival of the implants. The purpose of this study was to evaluate the cost-effectiveness of the use of alternative bearings in total hip arthroplasty.
A decision-analysis model was constructed to estimate the cost-effectiveness of the use of alternative bearings for patients undergoing total hip arthroplasty. Model inputs, including costs, clinical outcome probabilities, and health utility values, were derived from a review of the literature. Sensitivity analyses were performed to evaluate the impact of patient age at the time of surgery, implant costs, and reductions in revision rates on the cost-effectiveness of alternate bearing surfaces.
In a population of fifty-year-old patients, use of an alternative bearing with an incremental cost of 2000 dollars would be cost-saving over the individual's lifetime if it were associated with at least a 19% reduction in the twenty-year implant failure rate when compared with the failure rate for a conventional bearing. In a population of patients over the age of sixty-three years, the same implant would be associated with higher lifetime costs than would a conventional bearing, regardless of the presumed reduction in the revision rate. Conversely, an alternative bearing that adds only 500 dollars to the cost of a conventional total hip arthroplasty could be cost-saving in a population of patients over the age of sixty-five years, even if it were associated with only a modest reduction in the revision rate. In a population of patients over the age of seventy-five years, no alternative bearing would be associated with lifetime cost-savings, regardless of the cost or the presumed reduction in the revision rate.
The cost-effectiveness of alternative bearings is highly dependent on the age of the patient at the time of surgery, the cost of the implant, and the associated reduction in the probability of revision relative to that associated with conventional bearings. Our findings provide a quantitative rationale for requiring greater evidence of effectiveness in reducing the probability of implant failure when more costly alternative bearings are being considered, particularly for older patients. |
Author | Bozic, Kevin J Rubash, Harry E Morshed, Saam Silverstein, Marc D Kahn, James G |
Author_xml | – sequence: 1 givenname: Kevin J surname: Bozic fullname: Bozic, Kevin J email: bozick@orthosurg.ucsf.edu organization: Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus, MU 320W, San Francisco, CA 94143-0728, USA. bozick@orthosurg.ucsf.edu – sequence: 2 givenname: Saam surname: Morshed fullname: Morshed, Saam – sequence: 3 givenname: Marc D surname: Silverstein fullname: Silverstein, Marc D – sequence: 4 givenname: Harry E surname: Rubash fullname: Rubash, Harry E – sequence: 5 givenname: James G surname: Kahn fullname: Kahn, James G |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/16595459$$D View this record in MEDLINE/PubMed |
BookMark | eNo10L1OwzAUhmEPRbQUNmbkG0g4dhynGaEqP1UlBtq5OnFOGqPUjmK3qNfBDQMqTN_0PsN3xUbOO2LsVkAqBej75ePyPV2kAFqoEZsASJGUWZ6P2VUIHwCgFBSXbCx0XuYqLyfsaxOI-4YbH2JCTUMm2iM5CoGjw-4UbODRczpid8BI3NEnj2Ra5zu_sxS4ddwPsfU9Um1NSPm6JW7wrGIXaXD4S_KKcLBux8NhaNCcy-gjdry1PccfY_B9hyGertlFg12gm7-dss3TYj1_SVZvz6_zh1ViMq1UIkVVlRJmRaMyIYta6zojgaXKZrKASopSw6wiUyNoLUnJWsgKEIHkjKRp5JTdnd3-UO2p3vaD3eNw2v6_I78BYqRpTQ |
CitedBy_id | crossref_primary_10_1016_j_knee_2013_01_004 crossref_primary_10_3310_hta19100 crossref_primary_10_1016_j_arth_2008_03_005 crossref_primary_10_1016_S0276_1092_08_70023_3 crossref_primary_10_1016_j_jval_2013_06_021 crossref_primary_10_1007_s10195_016_0405_z crossref_primary_10_1016_j_ocl_2013_06_001 crossref_primary_10_1016_j_mporth_2009_01_006 crossref_primary_10_1007_s11999_015_4369_8 crossref_primary_10_1016_j_jot_2013_07_002 crossref_primary_10_1136_bmjopen_2012_001162 crossref_primary_10_1016_j_arth_2010_03_009 crossref_primary_10_3928_01477447_20100722_46 crossref_primary_10_1016_j_spinee_2008_01_015 crossref_primary_10_2217_17460816_3_4_329 crossref_primary_10_1016_j_jse_2009_11_057 crossref_primary_10_3310_pgfar05120 crossref_primary_10_1016_j_anai_2014_05_012 crossref_primary_10_1007_s11420_013_9352_x crossref_primary_10_1186_1471_2474_15_22 crossref_primary_10_1016_j_arth_2015_08_034 crossref_primary_10_1136_bcr_2022_252877 crossref_primary_10_1007_s12178_012_9139_6 crossref_primary_10_1007_s10195_008_0100_9 crossref_primary_10_1002_jbm_b_30674 crossref_primary_10_2214_AJR_07_3593 crossref_primary_10_12968_hmed_2010_71_8_77667 |
ContentType | Journal Article |
DBID | CGR CUY CVF ECM EIF NPM |
DOI | 10.2106/JBJS.E.00614 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) |
DatabaseTitleList | MEDLINE |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
DeliveryMethod | no_fulltext_linktorsrc |
ExternalDocumentID | 16595459 |
Genre | Research Support, Non-U.S. Gov't Journal Article |
GroupedDBID | .55 .GJ .XZ 07C 08G 08P 0R~ 123 1CY 1KJ 29K 2WC 34G 36B 39C 3O- 3V. 4.4 53G 5RE 5RS 6NX 7RV 7X7 88E 88I 8AF 8F7 8FI 8FJ 8R4 8R5 AAAAV AAAXR AAEJM AAFTM AAGIX AAHPQ AAIQE AAMOA AAQKA AASCR AAWTL AAXQO ABASU ABDIG ABJNI ABPMR ABUWG ABVCZ ABXVJ ACCJW ACEWG ACGFS ACGOD ACILI ACIWK ACNWC ACPRK ACRZS ACXJB ADGGA ADHPY ADNKB AEETU AFCHL AFDTB AFFNX AFKRA AFMFG AFRAH AFUWQ AHMBA AHOMT AHQNM AHVBC AI. AIJEX AINUH AJIOK AJJEV AJNWD AJNYG AJZMW AKULP ALMA_UNASSIGNED_HOLDINGS ALMTX AMJPA AMKUR AMNEI AOHHW AZQEC BENPR BKEYQ BOWHD BPHCQ BQLVK BVXVI C45 CCPQU CGR CS3 CUY CVF D-I DIWNM DUNZO DWQXO E3Z EBS ECM EEVPB EIF EJD ERAAH EX3 F5P FCALG FEDTE FYUFA GNUQQ GNXGY GQDEL H13 HCIFZ HLJTE HMCUK HVGLF H~9 IKREB IKYAY JG8 K-O L7B M1P M2P M5~ NAPCQ NPM O9- OCB OGEVE OHH OJAPA OPUJH OUVQU OVD OVDNE OVIDH OVLEI OXXIT PCD PQQKQ PROAC PSQYO PZZ Q2X RLZ SJN TEORI TJB TSPGW UKHRP VH1 VVN W1K WH7 WOQ WOW X7M YCJ YOC YQJ YRY ZGI ZXP ZY1 ZZMQN ~H1 ~ZZ |
ID | FETCH-LOGICAL-c3644-21bb92087f43127d66d3e1a9438270b219608becda0662e42d12b0aa0e28e2cf2 |
ISSN | 0021-9355 |
IngestDate | Sat Sep 28 07:47:53 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 4 |
Language | English |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-c3644-21bb92087f43127d66d3e1a9438270b219608becda0662e42d12b0aa0e28e2cf2 |
PMID | 16595459 |
ParticipantIDs | pubmed_primary_16595459 |
PublicationCentury | 2000 |
PublicationDate | 2006-April |
PublicationDateYYYYMMDD | 2006-04-01 |
PublicationDate_xml | – month: 04 year: 2006 text: 2006-April |
PublicationDecade | 2000 |
PublicationPlace | United States |
PublicationPlace_xml | – name: United States |
PublicationTitle | Journal of bone and joint surgery. American volume |
PublicationTitleAlternate | J Bone Joint Surg Am |
PublicationYear | 2006 |
SSID | ssj0004407 |
Score | 2.1664233 |
Snippet | Alternative bearing surfaces offer the potential to reduce wear and improve implant longevity following total hip arthroplasty. However, these technologies are... |
SourceID | pubmed |
SourceType | Index Database |
StartPage | 706 |
SubjectTerms | Aged Aged, 80 and over Arthroplasty, Replacement, Hip - economics Cost-Benefit Analysis Hip Prosthesis - economics Humans Middle Aged Prosthesis Design |
Title | Use of cost-effectiveness analysis to evaluate new technologies in orthopaedics. The case of alternative bearing surfaces in total hip arthroplasty |
URI | https://www.ncbi.nlm.nih.gov/pubmed/16595459 |
Volume | 88 |
hasFullText | |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lj9MwELa6cOGCQDyXh3zgtkqJUzdxjoAWVZXYA2ylva1sxxZB2qRqUyT2b_DP-EXM-JF6dwEBl6iKVTfxfB2P5_ENIa9g19DCzmfZ3GqecVmrTIDVn0lppWJNxbh0bJ8n5WLFl2fzs8nkR5K1tBvUVF_-sq7kf6QK90CuWCX7D5IdJ4Ub8BnkC1eQMFz_SsYr74jX_XbIfGJG1F0yco2AaRkIvQ12Dz8aoiu9dZlYRxi2gXMzhmu2U5d_oaWf1cXRO88LruD_4BwPu40NOVwws6ujbNfIk4TNFsAOH64EiRNjV_Wdj1N86dtuwHmwGHu6Dxh5LTk6B_rLVvuyoa_wU3tfdr_ZfjbBlS0vRvdQi_nd29i48wPyD4yZzB93sFM759FCbjbfQulF4ugY82Ni4QHLkA4-Vd5CJCDliSauHJHBjR0CTrjorFi-XX6aHmNSny9hTcCyvnBoYUi0yD1b-Z9Hr_F1x6EDclAJ1Lkn6D-Klbo8D02E_av4Ugx8qNfpIyGVbZjm2nHHmT2n98jdIEL6xoPvPpmY7gH5DsCjvaU3gUcj8OjQ0wg8CsCjKfBo29ErwKMAPIrAw1kT4NEAPBqBh990wKMAPJoC7yFZvT8-fbfIQnePTM_ACM8KplRd5KKyYMMWVVOWzcwwWWNkusoV7KRlLkDDNBKbFBheNKxQuZS5KYQptC0ekVsdgPcJoaw2zOKurcuaG1i0UlmmjGHKlrXh4il57NfwfO0pXM7j6h7-duQZubMH4XNy24LOMC_AAB3USyfTnzKrjKs |
link.rule.ids | 786 |
linkProvider | National Library of Medicine |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Use+of+cost-effectiveness+analysis+to+evaluate+new+technologies+in+orthopaedics.+The+case+of+alternative+bearing+surfaces+in+total+hip+arthroplasty&rft.jtitle=Journal+of+bone+and+joint+surgery.+American+volume&rft.au=Bozic%2C+Kevin+J&rft.au=Morshed%2C+Saam&rft.au=Silverstein%2C+Marc+D&rft.au=Rubash%2C+Harry+E&rft.date=2006-04-01&rft.issn=0021-9355&rft.volume=88&rft.issue=4&rft.spage=706&rft_id=info:doi/10.2106%2FJBJS.E.00614&rft_id=info%3Apmid%2F16595459&rft_id=info%3Apmid%2F16595459&rft.externalDocID=16595459 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0021-9355&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0021-9355&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0021-9355&client=summon |