Cemented, Cementless, and Hybrid Prostheses for Total Hip Replacement: Cost Effectiveness Analysis

Mark Pennington, lecturer in health economics, Richard Grieve, reader in health economics, Jasjeet S Sekhon, professor, Paul Gregg, professor and consultant orthopaedic surgeon, vice chairman, Nick Black, professor of health services research, Jan H van der Meulen, professor of clinical epidemiology

Abstract

Objective To compare the cost effectiveness of the three most commonly chosen types of prosthesis for total hip replacement.

Design Lifetime cost effectiveness model with parameters estimated from individual patient data obtained from three large national databases.

Setting English National Health Service.

Participants Adults aged 55 to 84 undergoing primary total hip replacement for osteoarthritis.

Interventions Total hip replacement using either cemented, cementless, or hybrid prostheses.

Main outcome measures Cost (£), quality of life (EQ-5D-3L, where 0 represents death and 1 perfect health), quality adjusted life years (QALYs), incremental cost effectiveness ratios, and the probability that each prosthesis type is the most cost effective at alternative thresholds of willingness to pay for a QALY gain.

Results Lifetime costs were generally lowest with cemented prostheses, and postoperative quality of life and lifetime QALYs were highest with hybrid prostheses. For example, in women aged 70 mean costs were £6900 ($11 000; €8200) for cemented prostheses, £7800 for cementless prostheses, and £7500 for hybrid prostheses; mean postoperative EQ-5D scores were 0.78, 0.80, and 0.81, and the corresponding lifetime QALYs were 9.0, 9.2, and 9.3 years. The incremental cost per QALY for hybrid compared with cemented prostheses was £2500. If the threshold willingness to pay for a QALY gain exceeded £10 000, the probability that hybrid prostheses were most cost effective was about 70%. Hybrid prostheses have the highest probability of being the most cost effective in all subgroups, except in women aged 80, where cemented prostheses were most cost effective.

Conclusions Cemented prostheses were the least costly type for total hip replacement, but for most patient groups hybrid prostheses were the most cost effective. Cementless prostheses did not provide sufficient improvement in health outcomes to justify their additional costs.