One-stage vs two-stage bilateral THA in Lombardy: a cost-effectiveness analysis

• Published in: Cost effectiveness and resource allocation Vol. 21; no. 1; p. 3
• Main Authors: Pironti, Pierluigi, Ambrosanio, Andrea, Vismara, Valeria, Viganò, Marco, Bucci, Eugenia, Sirtori, Paolo, Peretti, Giuseppe M, Mangiavini, Laura
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.01.2023; BioMed Central; BMC
• Subjects: Anterior approach; Antiarthritic agents; Bilateral total hip arthroplasty; Comparative analysis; Cost benefit analysis; Cost-effectiveness; Economic aspects; Hemoglobin; Osteoarthritis; Anterior approach; Bilateral total hip arthroplasty; Cost-effectiveness
• ISSN: 1478-7547; 1478-7547
• DOI: 10.1186/s12962-023-00418-y

Total hip arthroplasty (THA) is the most common treatment for primary and secondary end-stage hip osteoarthritis (OA). Almost 20% of all patients undergoing primary THA suffer from bilateral hip OA and, consequently, will need a contralateral procedure to be performed in the following years. The aim of this study is to evaluate the cost-effectiveness and the reliability of one-stage bilateral THA (1-BTHA) compared to two-stage bilateral THA (2-BTHA), in low-risk patients, performed with anterior minimally invasive surgery (AMIS). Single patient's costs were obtained by dividing the annual costs report by the number of hospitalizations, considering the diagnosis related group (DRG) of the two procedures. Then, 16 patients undergoing 1-BTHA and 8 undergoing 2-BTHA were examined. Hemoglobin (Hb) values before surgery and before discharge, transfusion rate and the occurrence of post-operative complications were observed. Procedural costs were divided in different subgroups: pre-hospitalization, operating room, hospital stay, post-operative follow-up and other costs. 1-BTHA total costs amount to 5.754,82€, while performing 2-BTHA costs 7.624,32€. However, considering DRG reimbursement, the hospital's profit margin following 1-BTHA is lower than that following 2-BTHA (6.346,18€ versus 9.261,68€). Surgical time was found not to be significantly different between 1-BTHA and 2-BTHA (141,13 ± 26,1 min vs 164,8 ± 44,3 min; p = 0,111). The two groups showed a statistically significant difference in Hb decrease (4,8 ± 1,3 g/dl vs 3,3 ± 0,9; p = 0,001), despite no variances in transfusion rate. No further complications were observed in either group. This study demonstrates how, in carefully selected patients, 1-BTHA performed with AMIS is a cost-effective and safe technique compared to 2-BTHA, resulting in a shorter OR time, LOS and lower overall costs. III.