The Economic Impact of Acetabular Labral Tears: A Cost-Effectiveness Analysis Comparing Hip Arthroscopy and Structured Rehabilitation Alone

Abstract

Hip arthroscopy is a successful procedure to manage acetabular labral tears and concurrent hip pathology, which if left untreated, may contribute to hip osteoarthritis (OA). It is essential to analyze the economic impact of this treatment option. This study assessed the cost-effectiveness of arthroscopic repair compared to structured rehabilitation alone for labral tears. A cost-effectiveness analysis of hip arthroscopy compared to structured rehabilitation for symptomatic labral tears was performed using a Markov decision model over a lifetime horizon. Direct costs (in 2014 USD), utilities of health states (in quality-adjusted life years [QALYs] gained), and probabilities of transitioning between health states were estimated from a literature review. Costs were estimated using national averages of Medicare reimbursements, adjusted for all-payers in the US. Utilities were estimated from Harris Hip Scores. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to determine the effect of uncertainty. For a cohort representative of hip arthroscopy patients at our facility, arthroscopy was more costly (additional $2653) but generated more utility (additional 3.94 QALYs), compared to rehabilitation. The mean ICER was $754/QALY, well below the conventional willingness-to-pay (WTP) threshold of $50,000/QALY. Arthroscopy is expected to be cost-effective for 94.5% of patients. Although arthroscopy decreased in cost-effectiveness with increasing age, it remained cost-effective for patients in the second to seventh decades of life. Lifetime incidence of symptomatic hip OA was twice as high for patients treated for rehabilitation compared to arthroscopy. The preferred treatment was sensitive to the utility following successful hip arthroscopy, although the utility at which arthroscopy becomes less cost-effective than rehabilitation is far below our best estimate. Hip arthroscopy is more cost-effective resulting in lower incidence of symptomatic OA than structured rehabilitation alone, when treating symptomatic labral tears of patients in the second to seventh decades of life.