Does age or bilateral disease influence the value of hip arthroplasty?

Abstract

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