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Clinical Orthopaedics and Related Research®

, Volume 474, Issue 12, pp 2645–2654

First Online: 03 October 2016Received: 04 March 2016Accepted: 09 September 2016DOI: 10.1007-s11999-016-5084-9

Cite this article as: Koenig, L., Zhang, Q., Austin, M.S. et al. Clin Orthop Relat Res 2016 474: 2645. doi:10.1007-s11999-016-5084-9

Abstract

BackgroundDemand for total hip arthroplasty THA is high and expected to continue to grow during the next decade. Although much of this growth includes working-aged patients, cost-effectiveness studies on THA have not fully incorporated the productivity effects from surgery.

Questions-PurposesWe asked: 1 What is the expected effect of THA on patients’ employment and earnings? 2 How does accounting for these effects influence the cost-effectiveness of THA relative to nonsurgical treatment?

MethodsTaking a societal perspective, we used a Markov model to assess the overall cost-effectiveness of THA compared with nonsurgical treatment. We estimated direct medical costs using Medicare claims data and indirect costs employment status and worker earnings using regression models and nonparametric simulations. For direct costs, we estimated average spending 1 year before and after surgery. Spending estimates included physician and related services, hospital inpatient and outpatient care, and postacute care. For indirect costs, we estimated the relationship between functional status and productivity, using data from the National Health Interview Survey and regression analysis. Using regression coefficients and patient survey data, we ran a nonparametric simulation to estimate productivity probability of working multiplied by earnings if working minus the value of missed work days before and after THA. We used the Australian Orthopaedic Association National Joint Replacement Registry to obtain revision rates because it contained osteoarthritis-specific THA revision rates by age and gender, which were unavailable in other registry reports. Other model assumptions were extracted from a previously published cost-effectiveness analysis that included a comprehensive literature review. We incorporated all parameter estimates into Markov models to assess THA effects on quality-adjusted life years and lifetime costs. We conducted threshold and sensitivity analyses on direct costs, indirect costs, and revision rates to assess the robustness of our Markov model results.

ResultsCompared with nonsurgical treatments, THA increased average annual productivity of patients by USD 9503 95% CI, USD 1446–USD 17,812. We found that THA increases average lifetime direct costs by USD 30,365, which were offset by USD 63,314 in lifetime savings from increased productivity. With net societal savings of USD 32,948 per patient, total lifetime societal savings were estimated at almost USD 10 billion from more than 300,000 THAs performed in the United States each year.

ConclusionsUsing a Markov model approach, we show that THA produces societal benefits that can offset the costs of THA. When comparing THA with other nonsurgical treatments, policymakers should consider the long-term benefits associated with increased productivity from surgery.

Level of EvidenceLevel III, economic and decision analysis.

Five authors AS, BD, CF, JTN, LK are employees of KNG Health Consulting, LLC, Rockville, MD, USA. Qian Zhang performed the work while employed with KNG Health Consulting, LLC. She currently works at the Maryland Health Care Commission Baltimore, MD, USA.

The institution of one or more of the authors AS, BD, CF, JTN, LK, QZ has received, during the study period, funding from the American Association of Hip and Knee Surgeons, Advocacy from Improvement in Mobility, DePuy Synthes, and Smith and Nephew.

One of the authors certifies that he MSA or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Zimmer Biomet Warsaw, IN, USA, an amount of USD 10,000-100,000 from Waldemar LINK GmbH and Co KG Hamburg, Germany, and an amount of USD 10,000- USD 100,000 from JayPee Brothers Medical Publishers New Delhi, India.

One of the authors certifies that he TKF or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001-USD 1,000,000 from DePuy-JandJ Co Warsaw, IN, USA.

One of the authors certifies that he RCM or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000- USD 100,000 from Stryker Kalamazoo, MI, USA, and an amount of USD 10,000- USD 100,000 from Smith and Nephew London, United Kingdom.

One of the authors certifies that he BDS or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Stryker Orthopaedics Mahwah, NJ, USA and an amount of USD 10,000- USD 100,000 from ConvaTec Surgical Greensboro, NC, USA.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at KNG Health Consulting, Rockville, MD, USA.

Electronic supplementary materialThe online version of this article doi:10.1007-s11999-016-5084-9 contains supplementary material, which is available to authorized users.

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Author: Lane Koenig - Qian Zhang - Matthew S. Austin - Berna Demiralp - Thomas K. Fehring - Chaoling Feng - Richard C. MatherIII

Source: https://link.springer.com/







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