Cost-Effectiveness Analysis of Early versus Late Total Hip Replacement in Italy

ObjectiveTo assess the cost-effectiveness of early primary total hip replacement (THR) for functionally independent older adult patients with osteoarthritis (OA) versus 1) nonsurgical therapy followed by THR once the patient has progressed to a functionally dependent state (“delayed THR”) and 2) nonsurgical therapy alone (‘medical therapy’), from the Italian National Health Service perspective.MethodsIndividual patient data and evidence from published literature on disease progression, economic costs and THR outcomes in OA, including utilities, perioperative mortality rates, prosthesis survival, and costs of prostheses, THR, rehabilitation, follow-up, revision, and nonsurgical management, combined with population life tables, were synthesized in a Markov model of OA. The model represents the lifetime experience of a patient cohort following their treatment choice, discounting costs and benefits (quality-adjusted life-years) at 3% annually.ResultsAt age 65 years, the incremental cost per quality-adjusted life-year of THR over delayed THR was €987 in men and €466 in women; the figures for delayed THR versus medical therapy were €463 and €82, respectively. Among 80-year-olds, early THR is (extended) dominant. With gradual utility loss after primary THR, delaying surgery may be more appealing in women than in men in their 50s, because longer female life expectancy implies longer latter periods of low health-related quality of life (HRQOL) with early THR.ConclusionsTHR is cost-effective. Patients’ HRQOL benefits forgone with delayed THR are worth more than the costs it saves to the Italian National Health Service. This analysis might help to explain women's consistently lower HRQOL by the time of primary operation.