Abstract
PurposeThe primary aim of this study was to determine the cost-effectiveness of total hip arthroplasty (THA) in patients aged 25 years and under by calculating the cost per quality-adjusted life year (QALY) gained at 10 years post-operatively, and over the course of a lifetime. Secondary aims were to describe the change in health-related quality of life (HRQoL), Oxford hip score (OHS), and satisfaction in these patients.MethodsFrom 2000 to 2016, 33 patients undergoing THA aged 25 and under had pre-operative and one-year post-operative EuroQol five-dimensions (EQ-5D) scores and OHS recorded prospectively. Post-operative change in EQ-5D allowed calculation of a health-utility score, which, when combined with life expectancy, gave total QALYs gained.ResultsThe mean age was 20 years (range 13.3-24.9), with 23 females (72.7%). Mean number of QALYs gained was 21.1 (95% CI 14.1-28.2). Total lifetime cost per patient was £14641, giving a mean cost per QALY of £4183 at 10 years post-operatively, and £694 over the total remaining lifetime. Discounting total QALYs gained at a rate of 3.5% and 5% per remaining year of life expectancy increased the mean cost per QALY to £1652 and £2187, respectively. Mean pre- and post-operative EQ-5D index were 0.27 (SD 0.27) and 0.63 (SD 0.29), respectively (p=0.0001). Mean pre-operative and post-operative OHS was 37.5 (SD 7.9) and 19.7 (SD 6.94), respectively (p<0.00001).ConclusionTHA remains a cost-effective intervention for patients aged 25 years and under. It is also associated with significant improvement in HRQoL, OHS, and high levels of patient satisfaction in this unique patient group.
Highlights
The number of patients undergoing total hip arthroplasty (THA) is increasing [1] and the average age of these patients is decreasing
Discounting total quality-adjusted life year (QALY) gained at a rate of 3.5% and 5% per remaining year of life expectancy increased the mean cost per QALY to £1652 and £2187, respectively
Discounting total QALYs gained at a rate of 3.5% and 5% per remaining year of life expectancy increased the mean cost per QALY to £1652 and £2187, respectively, over the remaining life expectancy (Table 2)
Summary
The number of patients undergoing total hip arthroplasty (THA) is increasing [1] and the average age of these patients is decreasing. Surgeons may cite young age at primary THA as a risk factor for future revision, and the survivorship and functional outcomes of THA in “super-young” patients aged 25 years and under is not well understood. This age range represents a patient cohort with unique functional requirements when compared to older patients, which may influence patient expectations and satisfaction [1]. Many patients requiring THA under the age of 25 years will have undergone previous hippreserving surgery, which may increase the complexity of the procedure [4] or the complication and revision rate [5]
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