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Arthroplasty

• P. J. Jenkins
• N. D. Clement
• D. F. Hamilton
• P. Gaston
• J. T. Patton
• C. R. Howie

Abstract

The aim of this study was to perform a cost–utilityanalysis of total hip (THR) and knee replacement (TKR). Arthritis isa disabling condition that leads to long-term deterioration in qualityof life. Total joint replacement, despite being one of the greatestadvances in medicine of the modern era, has recently come underscrutiny. The National Health Service (NHS) has competing demands,and resource allocation is challenging in times of economic restraint. Patientswho underwent THR (n = 348) or TKR (n = 323) between January andJuly 2010 in one Scottish region were entered into a prospectivearthroplasty database. A health–utility score was derived from theEuroQol (EQ-5D) score pre-operatively and at one year, and was combinedwith individual life expectancy to derive the quality-adjusted life years(QALYs) gained. Two-way analysis of variance was used to compareQALYs gained between procedures, while controlling for baselinedifferences. The number of QALYs gained was higher after THR thanafter TKR (6.5vs 4.0 years, p < 0.001). Thecost per QALY for THR was £1372 compared with £2101 for TKR. Thepredictors of an increase in QALYs gained were poorer health beforesurgery (p < 0.001) and younger age (p < 0.001). General health(EQ-5D VAS) showed greater improvement after THR than after TKR(p < 0.001). This study provides up-to-date cost-effectivenessdata for total joint replacement. THR and TKR are extremely effectiveboth clinically and in terms of cost effectiveness, with costs thatcompare favourably to those of other medical interventions.

Cite this article:Bone Joint J 2013;95-B:115–21.

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