In the JournalsPerspective

Hip arthroscopy potentially a cost-effective treatment for FAI patients without arthritis

Shearer DW. Clin Orthop Rel Res. 2011. doi: 10.1007/s11999-011-2023-7

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A favorable incremental cost-effectiveness ratio may be achieved through the arthroscopic treatment of patients who have femoracetabular impingement without arthritis, according to researchers in California.

The incremental cost-effectiveness ratio (ICER) found for hip arthroscopy in such patients was considered favorable when compared to other interventions considered cost-effective, the authors wrote.

The authors of the study put together a Markov model that included possible health states for 36-year-old patients with femoroacetabular impingement (FAI). They used this model to compare the strategies of observation and hip arthroscopy, with the hip arthroscopy being followed with total hip arthroplasty (THA) as the disease progressed.

Health-related quality of life was used to help estimate the ratio of incremental costs to benefits for each strategy, with health state preferences and probabilities being determined through studies that had previously reported Harris hip scores and complications following arthroscopy. The authors also examined 30 input variables to help determine the influence of uncertainty on the ICER.

Those patients with FAI but no arthritis displayed an estimated hip arthroscopy ICER of $21,700 per quality-adjusted life year (QALY), while those patients who did have preoperative arthritis were found to display an ICER of $79,500 per QALY. Use of hip arthroscopy to alter the natural history of arthritis improved the patient’s ICER to $19,200 per QALY — and, the authors wrote, “resulted in cost savings if THA was not performed until at least 16 years after arthroscopy.”

“Further studies of hip arthroscopy are needed to determine the impact on quality of life, duration of symptomatic relief, and the effect on the need for subsequent THA,” the authors wrote.

Perspective

This study has timely relevance as more emphasis is placed on evidence-based and cost-effectiveness. Despite many assumptions (the authors acknowledge such), the authors should be commended as this model-based approach to estimate the ICER of hip arthroscopy in the treatment of symptomatic FAI provides insight into the relative value of this increasingly common surgical procedure. The arthroscopic management of FAI in the absence of radiographic osteoarthritis may be cost-effective particularly if arthroscopic intervention can prevent or forestall hip arthroplasty which is yet to be substantiated.

In their analysis, hip arthroscopy had favorable cost-effectiveness when providing significant improved quality of life for more than 13 months regardless of any impact on the need for THA. Moreover, if it could forestall THA for 5 years, hip arthroscopy had a highly favorable cost-effectiveness ratio. If it could delay THA for 16 years, hip arthroscopy actually became cost-saving. I would also submit that "value" is not always financial; patients with symptomatic FAI (I know because I was one) may still find personal value from this outpatient arthroscopic procedure even if they eventually proceed to hip arthroplasty.

— Dean K. Matsuda, MD
Orthopedics Today Editorial board member

Disclosure: Matsuda has no relevant financial disclosures.

Discuss in OrthoMind
Discuss in OrthoMind

A favorable incremental cost-effectiveness ratio may be achieved through the arthroscopic treatment of patients who have femoracetabular impingement without arthritis, according to researchers in California.

The incremental cost-effectiveness ratio (ICER) found for hip arthroscopy in such patients was considered favorable when compared to other interventions considered cost-effective, the authors wrote.

The authors of the study put together a Markov model that included possible health states for 36-year-old patients with femoroacetabular impingement (FAI). They used this model to compare the strategies of observation and hip arthroscopy, with the hip arthroscopy being followed with total hip arthroplasty (THA) as the disease progressed.

Health-related quality of life was used to help estimate the ratio of incremental costs to benefits for each strategy, with health state preferences and probabilities being determined through studies that had previously reported Harris hip scores and complications following arthroscopy. The authors also examined 30 input variables to help determine the influence of uncertainty on the ICER.

Those patients with FAI but no arthritis displayed an estimated hip arthroscopy ICER of $21,700 per quality-adjusted life year (QALY), while those patients who did have preoperative arthritis were found to display an ICER of $79,500 per QALY. Use of hip arthroscopy to alter the natural history of arthritis improved the patient’s ICER to $19,200 per QALY — and, the authors wrote, “resulted in cost savings if THA was not performed until at least 16 years after arthroscopy.”

“Further studies of hip arthroscopy are needed to determine the impact on quality of life, duration of symptomatic relief, and the effect on the need for subsequent THA,” the authors wrote.

Perspective

This study has timely relevance as more emphasis is placed on evidence-based and cost-effectiveness. Despite many assumptions (the authors acknowledge such), the authors should be commended as this model-based approach to estimate the ICER of hip arthroscopy in the treatment of symptomatic FAI provides insight into the relative value of this increasingly common surgical procedure. The arthroscopic management of FAI in the absence of radiographic osteoarthritis may be cost-effective particularly if arthroscopic intervention can prevent or forestall hip arthroplasty which is yet to be substantiated.

In their analysis, hip arthroscopy had favorable cost-effectiveness when providing significant improved quality of life for more than 13 months regardless of any impact on the need for THA. Moreover, if it could forestall THA for 5 years, hip arthroscopy had a highly favorable cost-effectiveness ratio. If it could delay THA for 16 years, hip arthroscopy actually became cost-saving. I would also submit that "value" is not always financial; patients with symptomatic FAI (I know because I was one) may still find personal value from this outpatient arthroscopic procedure even if they eventually proceed to hip arthroplasty.

— Dean K. Matsuda, MD
Orthopedics Today Editorial board member

Disclosure: Matsuda has no relevant financial disclosures.