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Costs and Cost-Effectiveness in Hip and Knee Replacements: A Prospective Study

Published online by Cambridge University Press:  10 March 2009

Pekka Rissanen ,
Seppo Aro ,
Harri Sintonen ,
Kimmo Asikainen ,
Pär Slätis  and
Pekka Paavolainen
Pekka Rissanen
Affiliation:
STAKES (National Research and Development Centre for Welfare and Health)
Seppo Aro
Affiliation:
STAKES (National Research and Development Centre for Welfare and Health)
Harri Sintonen
Affiliation:
University of Kuopio
Kimmo Asikainen
Affiliation:
STAKES (National Research and Development Centre for Welfare and Health)
Pär Slätis
Affiliation:
Invalid Foundation Hospital
Pekka Paavolainen
Affiliation:
Jorvi Hospital
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Abstract

The extensive benefits of the total hip (THA) and knee (TKA) replacements are well documented, but surprisingly little is known about their economics. We assessed costs, cost-effectiveness (C/E), and patient-related C/E variances in THA and TKA from data on 276 THA and 176 TKA patients. Patients with primary arthrosis, primary operation, and total joint replacement were recruited from seven hospitals between March 1991 and June 1992. Their use of health and other welfare services together with health-related quality of life (HRQoL) were measured before the surgery and at 6, 12, and 24 months postoperatively. HRQoL was assessed by the 15D, a 15-dimensional HRQoL instrument, and the Nottingham Health Profile. Costs were assessed from questionnaire responses, the Finnish Hospital Discharge Register, and Finnish Arthroplasty Register. Total hospital costs per patient were 45,000 FIM (US $10,500) for THA and 49,600 FIM (US $11,500) for TKA. Prosthesis costs comprised 21 % of these costs in THA and 24% in TKA. On average, hip patients gained more in terms of HRQoL, and the operations were more cost-effective. The C/E ratio for younger (« 60 years) knee patients did not differ from those in all age groups of hip patients, whereas TKAs in those over 60 years had a worse C/E ratio compared with all other patient subgroups. It was concluded that allocation efficiency can be improved by considering not only the intervention but also patient characteristics such as age. Indeed, the C/E ratio varied more across age groups of knee patients than between average THA and TKA patients.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 13 , Issue 4 , Fall 1997 , pp. 574 - 588
Copyright
Copyright © Cambridge University Press 1997

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References

REFERENCES

1.Adam, R. F., & Noble, J.Primary total knee arthroplasty in the elderly. Journal of Arthroplasty, 1994, 9, 495–97.Google Scholar
2.Barber, T. C., & Healy, W. L.Hospital cost of total hip arthroplasty: A comparison between 1981 and 1990. The Journal of Bone and Joint Surgery, 1993, 75–A, 321–25.Google Scholar
3.Bindman, A. B., Keane, D., & Lurie, N.Measuring health changes among severely ill patients: The floor phenomenon. Medical Care, 1990, 28, 1142–51.CrossRefGoogle Scholar
4.Boettcher, W. G.Total hip arthroplasties in the elderly: Morbidity, mortality, and cost effectiveness. Clinical Orthopaedics and Related Research, 1992, 274, 308–34.CrossRefGoogle Scholar
5.Chistianssen, T., Pedersen, K. M., Harvald, B., et al. An investigation of the effect of regional variation in the treatment of hypertension. Social Science and Medicine, 1989, 28, 131–39.CrossRefGoogle Scholar
6.Coast, J.The role of economic evaluation in setting priorities for elective surgery. Health Policy, 1993, 24, 243–57.CrossRefGoogle ScholarPubMed
7.Drugge, D., Frohling, H., Hägglund, Y., et al. . Cost analysis of arthrosis of hip. Acta Orthopedica Scandinavica, 1987, 58, 301–02.Google Scholar
8.Drummond, M., Torrance, G., & Mason, J.Cost-effectiveness league tables: More harm than good. Social Science and Medicine, 1993, 37, 33–40.Google Scholar
9.Friedman, B., & Elixhauser, A.Increased use of an expensive, elective procedure: Total hip replacements in the 1980s. Medical Care, 1993, 31, 581–99.CrossRefGoogle ScholarPubMed
10.Gerard, K., & Mooney, G.QALY league tables: Handle with care. Health Economics, 1993, 2, 59–64.Google Scholar
11.Goldie, I.Total hip and knee replacements. Acta Orthopedica Scandinavica, 1991, 62(suppl. 241), 23–26.CrossRefGoogle Scholar
12.Gudex, C.QALYs and their use by the Health Service. Discussion paper 20. York: University of York, CHE, 1986.Google Scholar
13.Hassenpflug, J., Harten, K., Hahne, H. J., et al. 1st die Implantation von Kniegelenkschar- nierendoprothesen heute noch vertbar? 15 Jahre Erfahrungen mit der Kniegelenkendo-prothese nach Blauth. Zeitschrift fur Orthopadie und Ihre Grenzgebiete, 1988, 126, 398–407.Google Scholar
14.Healy, W. L., & Finn, D.The hospital cost and the cost of the implant for total knee arthroplasty. Journal of Bone and Joint Surgery, 1994, 76-A, 801–06.Google Scholar
15.Holmberg, S.Life expectancy after total hip arthroplasty. The Journal of Arthroplasty, 1992, 7, 183–86.CrossRefGoogle ScholarPubMed
16.Hunt, S. M., McKenna, S. P., & McEven, J.A quantitative approach to perceived health status: A validation study. Journal of Epidemiology and Community Health, 1980, 34, 281–86.CrossRefGoogle ScholarPubMed
17.Hunt, S. M., McKenna, S. P., & Williams, J.Reliability of a population survey tool for measuring perceived health problems: A study of patients with osteoarthritis. Journal of Epidemiology and Community Health, 1981, 35, 297–300.Google Scholar
18.Jacobsson, S.-A., Rehnberg, C., & Djerf, K.Risks, benefits and economic consequences of total hip arthroplasty in an aged population. Scandinavian Journal of Social Medicine, 1991,19, 1972–78.Google Scholar
19.Jylhå, M., Jokela, J., Tolvanen, E., et al. The Tampere longitudinal study on aging. Scandinavian Journal of Social Medicine. 1992, 47(suppl.), 1–55.Google Scholar
20.Katz, J. N., Phillips, C. B., Fossel, A. H., & Liang, M. H.Stability and responsiveness of utility measures. Medical Care, 1994, 32, 183–99.Google Scholar
21.Knutson, K., Lewold, S., Robertsson, O., & Lindgren, L.The Swedish knee arthroplasty register. Ada Orthopedica Scandinavica, 1994, 64, 375–86.CrossRefGoogle Scholar
22.Liang, M. H., Cullen, K. E., Larson, M. G., et al. Cost-effectiveness of total joint arthroplasty in osteoarthritis. Arthritis and Rheumatism, 1986, 29, 937–3.CrossRefGoogle ScholarPubMed
23.Malchau, H., Herberts, P., & Ahnfeld, L.Prognosis of total hip replacement in Sweden: Follow-up of 92,675 operations performed 1978–1990. Acta Orthopedica Scandinavica, 1993, 64, 497–506.Google Scholar
24.Mason, J., Drummond, M., & Torrance, G.Some guidelines on the use of cost-effectiveness league tables. British Medical Journal, 1993, 306, 570–72.CrossRefGoogle ScholarPubMed
25.Mullahy, J., & Portney, P. R.Air pollution, cigarette smoking, and the production of respiratory health. Journal of Health Economics, 1990, 9, 193–205.Google Scholar
26.Munck, S., Pedersen, K. M., & Helmer-Hansen, H. B.A cost-effectiveness analysis of total hip replacement. Acta Orthopedica Scandinavica, 1987, 58, 326–27.Google Scholar
27.Munk, S., Hattens, E., & Andersen, P.Total hoftealloplastik. Langtidsökonomiske konsekvenser. Ugersk Laeger, 1991, 153, 1858–59.Google Scholar
28.NIH Consensus Conference. Total hip replacement. Journal of the American Medical Association, 1995, 273, 1950–56.Google Scholar
29.O'Brien, B. J., Drummond, M. F., Labelle, R. J., & Willan, A.In search of power and significance: Issues in the design and analysis of stochastic cost-effectiveness in health care. Medical Care, 1994, 32, 150–63.Google Scholar
30.Paavolainen, P., Slatis, P., Hämäläinen, M., et al. Long-term results of total joint arthroplasty. Helsinki: National Agency for Medicines, 1995.Google Scholar
31.Quam, J. P., Michet, C. J., Wilson, M. G., et al. Total knee arthroplasty: A population-based study. Mayo Clinic Proceedings, 1991, 66, 589–95.CrossRefGoogle ScholarPubMed
32.Rissanen, P., Aro, S., & Paavolainen, P.Hospital and patient related characteristics determining length of stay for hip and knee replacements. International Journal of Technology Assessment in Health Care, 1996, 12, 325–35.Google Scholar
33.Rissanen, P., Aro, S., Sintonen, H., et al. Quality of life and functional ability in hip and knee replacements: A prospective study. Quality of Life Research, 1996, 5, 56–64.Google Scholar
34.Rissanen, P., Aro, S., Slatis, P., et al. Health and quality of life before and after hip and knee arthroplasty. Journal of Arthroplasty, 1995, 10, 169–75.CrossRefGoogle Scholar
35.Sintonen, H.The 15-D measure of health-related quality of life: Reliability, validity and sensitivity of its health state descriptive system. NCHPE, Working Paper 41, Melbourne, 1994.Google Scholar
36.Sintonen, H.The 15-D measure of health related quality of life: Feasibility, reliability and validity of its valuation system. NCHPE, Working Paper 42, Melbourne, 1995.Google Scholar
37.Sintonen, H., & Pekurinen, M. A fifteen-dimensional measure of health-related quality of life (15D) and its applications. In Walker, S. R. & Rosser, R. M. (eds.), Quality of life assessment: Key issues in the 1990s. Dordrecht: Kluwer Academic Publishers, 1993, 185–95.CrossRefGoogle Scholar
38.Sintonen, H., & Tuominen, R.Exploring determinants of peridontal treatment costs: A special focus on cigarette smoking. Social Science and Medicine, 1989, 29, 835–44.CrossRefGoogle Scholar
39.Taylor, D. G.The costs of arthritis and the benefits of joint replacement surgery. Proceedings of the Royal Society of London Bulletin, 1976, 192, 145–55.Google ScholarPubMed
40.Van Hout, B. A., Al, M. J., Gordon, G. S., & Rutten, H. F. H.Costs, effects and C/E ratios alongside clinical trial. Health Economics, 1994, 3, 309–19.CrossRefGoogle Scholar
41.Wakker, P., & Klaassen, M. P.Confidence intervals for cost/effectiveness ratios. Health Economics, 1995, 4, 373–81.CrossRefGoogle ScholarPubMed
42.Weinstein, M. C.Principles of cost-effective allocation in health care organizations. International Journal of Technology Assessment in Health Care, 1990, 6, 93–103.CrossRefGoogle ScholarPubMed
43.Williams, A.Economics of coronary artery bypass grafting. British Medical Journal 1985, 291, 326–29.Google Scholar
44.Zicat, B., Rorabeck, C. H., Bourne, R. B., et al. Total knee arthroplasty in the octagenarian. Journal of Arthroplasty, 1993, 8, 395–400.CrossRefGoogle Scholar