PMS32 A COST EFFECTIVENESS ASSESSMENT OF DUAL MOBILITY BEARINGS IN REVISION HIP ARTHROPLASTY

Abstract

Dislocation rates of traditional single bearing (SB) implants in revision total hip arthroplasty (THA) have been reported to be 8-10%. The use of Dual Mobility (DM) bearings can reduce this risk to 0.5-2%. However, DM bearings are more costly and is not clear if the additional clinical benefits constitute value for money for the payers. We aim to estimate the cost-effectiveness of DM bearing compared to SB for patients undergoing revision THA. We developed a Markov model over 5, 10 and 14 year time horizon, to estimate the expected cost and benefits of DM compared to SB in patients undergoing revision THA. The transition probabilities for revision, re-revisions, post-operative mortality was estimated from the published United Kingdom National Joint Registry and published literature and stratified by sex and age. Implant and healthcare costs were estimated from local procurement prices and national tariffs. Quality-adjusted life-years (QALY) were calculated using published utility estimates for patients undergoing THA. At a minimum five years follow up, DM was cost-effective with an estimated incremental cost-effectiveness ratio (ICER) of between £3,006 to £18,745/ QALY for patients <55 years and 64-75 years respectively. For those aged >75 years DM was only cost-effective if the time horizon was beyond 7 years or more. DM was cost-saving for ages less than 75 and cost-effective for over 75 years if the time horizon was 10 or more years. DM is cost-effective when compared with SB in patients undergoing revision THA. The younger the patient is, the more likely that a DM bearing is more cost-effective. The results are affected by the time horizon and cost of bearings for those aged over 75 years. For patients over 75 years, it must be left to the discretion of the clinician to consider if usage remains an economic and clinical option.