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Does Age or Bilateral Disease Influence the Value of Hip Arthroplasty?

  • Symposium: Value Based Healthcare
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Measuring value in medicine is an increasingly important issue as healthcare spending continues to rise and cost containment becomes even more important. However, value assessments can be affected by patient factors and comorbidities.

Questions/purposes

We therefore quantified the approximate value of total hip arthroplasty and determined if patient age and Charnley classification affected the EuroQol5D (EQ5D) after hip arthroplasty.

Methods

Using charge data and an institutional joint registry, we evaluated 1442 patients after hip arthroplasty. Using the Charnley case-mix index to define bilateral disease and age of 65 years to distinguish between elderly and young patients, statistical comparisons were made among all groups. We obtained subspecialty physician charges and hospital charges.

Results

Patients with both unilateral and bilateral disease in both age groups had improved EQ5D scores after total hip arthroplasty, and the average change in scores was 0.27. There was no difference in the change in utility scores when patients older than 65 years of age were compared with patients younger than 65 years or when patients with unilateral disease were compared with those with bilateral disease. The average cost per quality-adjusted life-year (QALY) gained was $9773/QALY.

Conclusions

Our data suggest the value of total hip arthroplasty compares favorably with other medical and surgical interventions for other patient groups. No adjustments for patient age or disease status of the contralateral limb are necessary when reporting the value of total hip arthroplasty.

Level of Evidence

Level IV, economic and decision analyses study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank David Zurakowski for performing all of the statistical analyses in this article.

Author information

Authors and Affiliations

  1. Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Bryan M. Lawless MD, Meridith Greene BA, Young-Min Kwon MD, PhD & Henrik Malchau MD, PhD

  2. NYU Hospital for Joint Disease, New York, NY, USA

    James Slover MD, MS

Authors
  1. Bryan M. Lawless MD
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  2. Meridith Greene BA
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  3. James Slover MD, MS
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  4. Young-Min Kwon MD, PhD
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  5. Henrik Malchau MD, PhD
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Corresponding author

Correspondence to Henrik Malchau MD, PhD.

Additional information

One of the authors (HM) receives royalties from Smith and Nephew and is a paid consultant for Biomet and Smith and Nephew. The institution receives support from Zimmer, DePuy, Biomet, Smith and Nephew, and MAKO.

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.

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Lawless, B.M., Greene, M., Slover, J. et al. Does Age or Bilateral Disease Influence the Value of Hip Arthroplasty?. Clin Orthop Relat Res 470, 1073–1078 (2012). https://doi.org/10.1007/s11999-011-2118-1

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  • DOI: https://doi.org/10.1007/s11999-011-2118-1

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