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Dual mobility implants may bring cost savings to routine primary THA
From a societal perspective, newer-generation dual mobility implants that meet specific economic and clinical thresholds can be cost saving for routine primary total hip arthroplasty vs. the use of conventional bearings, according to results.
To evaluate the incremental cost and effectiveness of primary unilateral hip osteoarthritis treatment with either dual mobility total hip implants or conventional total hip implants, Alexander S. McLawhorn, MD, MBA, and colleagues performed a cost-utility analysis using a state-transition Markov model. Researchers derived costs, expressed in 2013 U.S. dollars, from the literature, the National Inpatient Sample and CMS, and expressed effectiveness in quality-adjusted life years (QALYs). Health state utilities and state transition probabilities derived from previously published literature populated the model, according to researchers. Researchers performed the analysis for a patient’s lifetime. They discounted costs and effectiveness at 3% annually. The incremental cost-effectiveness ratio, with a willingness-to-pay threshold of $100,000 per QALY was considered the principle outcome by researchers.
Investigators noted results showed “absolute dominance” of dual mobility total hip arthroplasty (THA) over conventional THA in the base case. The example showed lower accrued costs and higher accrued utility, which indicated cost savings. However, when the dual mobility implant costs exceeded those of conventional THA by $1,023 and the cost-effectiveness threshold for dual mobility implants was $5,287 greater than that for conventional implants, researchers found dual mobility THA ceased being cost saving. Researchers also noted when the annualized incremental probability of revision from any unforeseen failure mechanism or mechanisms exceeded 0.29% dual mobility was not cost-effective. According to results, the probability of intraprosthetic dislocation had the most influence on model outcomes. – by Casey Tingle
Disclosure s : Barlow and McLawhorn report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.