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BMC Health Services Research

, 14:342

Utilization, expenditure, economics and financing systems


BackgroundTo facilitate the discussion on the increasing number of total hip replacements THR and their effectiveness, we apply a joint evaluation of hospital case costs and health outcomes at the patient level to enable comparative effectiveness research CER based on the preoperative health state.

MethodsIn 2012, 292 patients from a German orthopedic hospital participated in health state evaluation before and 6 months after THR, where health-related quality of life HRQoL and disease specific pain and dysfunction were analyzed using EQ-5D and WOMAC scores. Costs were measured with a patient-based DRG costing scheme in a prospective observation of a cohort. Costs per quality-adjusted life year QALY were calculated based on the preoperative WOMAC score, as preoperative health states were found to be the best predictors of QALY gains in multivariate linear regressions.

ResultsMean inpatient costs of THR were 6,310 Euros for primary replacement and 7,730 Euros for inpatient lifetime costs including revisions. QALYs gained using the U.K. population preference-weighted index were 5.95. Lifetime costs per QALY were 1,300 Euros.

ConclusionsThe WOMAC score and the EQ-5D score before operation were the most important predictors of QALY gains. The poorer the WOMAC score or the EQ-5D score before operation, the higher the patient benefit. Costs per QALY were far below common thresholds in all preoperative utility score groups and with all underlying calculation methodologies.

KeywordsHealth-related quality of life Costs Cost-effectiveness Cost-utility QALY EQ-5D WOMAC Total hip replacement Hip AbbreviationsACERAverage cost-effectiveness ratio

ASAAmerican Society of Anesthesiologists

CERComparative effectiveness research

DRGDiagnosis related group

HRQoLHealth-related quality of life

EB-QALYExperience-based quality-adjusted life year

EQ-5DEuroQol 5-dimension

EQ-5D VASEuroQol 5-dimension visual analogue scale

ICERIncremental cost-effectiveness ratio

InEKInstitute for the Hospital Remuneration System

NICENational Institute of Health and Care Excellence

NHSNational Health Service

OLSOrdinary least squares

PROMsPatient-reported outcome measures

THRTotal hip replacement

TTOTime trade-off

QALYQuality-adjusted life year

VAS-ALVisual analogue scale adjusted life years

WOMACWestern Ontario and McMaster Universities Arthritis Index.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-14-342 contains supplementary material, which is available to authorized users.

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Autor: Matthias Vogl - Rainer Wilkesmann - Christian Lausmann - Werner Plötz


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