Researchers in the United Kingdom who performed a cost analysis of three types of hip prostheses found cemented prosthesis cost the least, hybrid prostheses were the most cost-effective and cementless prostheses were the most expensive.
“This study questions the increased use of cementless prostheses for total hip replacement,” the authors wrote in their study abstract. “Cemented prostheses are the cheapest option, but hybrid prostheses lead to greater gains in mean postoperative quality of life and are the most cost-effective alternative for most patients. Cementless prostheses do not improve health outcomes sufficiently to justify their higher costs.”
Using information from three National Health Service (NHS) databases, the investigators compared patients aged 55 years to 84 years who underwent cemented, cementless or hybrid total hip replacements (THRs). Outcome measures included cost, quality of life (EQ-5D-3L), quality-adjusted life years (QALYs), incremental cost-effectiveness ratios and the “probability that each prosthesis type is the most effective at alternative thresholds of willingness to pay for a QALY gain,” according to the study abstract.
Costs were lowest for cemented prostheses, and hybrid prostheses had the highest postoperative quality of life and lifetime QALYs. The mean EQ-5D score was 0.78 for cemented, 0.80 for cementless and 0.81 for hybrid prostheses. The average QALYs were 9.0 years for cemented, 9.2 years for cementless and 9.3 years for hybrid prostheses. Hybrid prostheses were more cost- effective 70% of the time when the incremental cost per QALY exceeded £10,000.