Rehabilitation after resurfacing hip arthroplasty: cost-utility analysis alongside a randomized controlled trial

Abstract

Objective: To assess the costs, effects, and cost-utility of an accelerated physiotherapy programme versus a standard physiotherapy programme following resurfacing hip arthroplasty. Design: A cost-utility analysis alongside a randomized controlled trial. Setting: A UK National Health Service hospital and patients’ homes. Subjects: A total of 80 male resurfacing hip arthroplasty patients randomized post procedure to one of the two programmes. Interventions: The accelerated physiotherapy programme commenced in hospital with patients being fully weight bearing, without hip precautions, and following a range of exercises facilitating gait re-education, balance, and lower limb strength. Standard physiotherapy commenced in hospital, but hip precautions were used and exercises were only partially weight bearing. In both groups, patients continued with their exercises at home for an eight-week period. Main measures: Data on healthcare contacts were collected from patients to 12 months and costed using unit costs from national sources. Information was also collected on patients’ costs. Health-related quality of life was measured using the EuroQol EQ-5D questionnaire and used to estimate quality-adjusted life years (QALYs) to 12 months. Mean costs and QALYs for each trial arm were compared. Results: On average, the accelerated physiotherapy programme was less expensive (mean cost difference −£200; 95% confidence interval: −£656 to £255) and more effective (mean QALY difference 0.13; 95% confidence interval: 0.05 to 0.21) than standard physiotherapy and had a high probability of being cost-effective. Conclusion: From the National Health Service perspective, an accelerated physiotherapy programme for male patients undergoing revision of total hip arthroplasty (RHA) is very likely to be cost-effective when compared to a standard physiotherapy programme.