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AIMS: To assess how the cost-effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) varies with age, sex, and preoperative Oxford Hip or Knee Score (OHS/OKS); and to identify the patient groups for whom THA/TKA is cost-effective. METHODS: We conducted a cost-effectiveness analysis using a Markov model from a United Kingdom NHS perspective, informed by published analyses of patient-level data. We assessed the cost-effectiveness of THA and TKA in adults with hip or knee osteoarthritis compared with having no arthroplasty surgery during the ten-year time horizon. RESULTS: THA and TKA cost < £7,000 per quality-adjusted life-year (QALY) gained at all preoperative scores below the absolute referral thresholds calculated previously (40 for OHS and 41 for OKS). Furthermore, THA cost < £20,000/QALY for patients with OHS of ≤ 45, while TKA was cost-effective for patients with OKS of ≤ 43, since the small improvements in quality of life outweighed the cost of surgery and any subsequent revisions. Probabilistic and one-way sensitivity analyses demonstrated that there is little uncertainty around the conclusions. CONCLUSION: If society is willing to pay £20,000 per QALY gained, THA and TKA are cost-effective for nearly all patients who currently undergo surgery, including all patients at and above our calculated absolute referral thresholds. Cite this article: Bone Joint J 2020;102-B(7):950-958.

Original publication

DOI

10.1302/0301-620X.102B7.BJJ-2019-0105.R2

Type

Journal article

Journal

Bone joint j

Publication Date

07/2020

Volume

102-B

Pages

950 - 958

Keywords

Arthroplasty, Cost-utility analysis, Economic evaluation, Hip, Joint arthroplasty, Knee, Osteoarthritis, Aged, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Cost-Benefit Analysis, Female, Humans, Male, Markov Chains, Middle Aged, Osteoarthritis, Hip, Osteoarthritis, Knee, Patient Reported Outcome Measures, Probability, Quality-Adjusted Life Years, Referral and Consultation, United Kingdom