University of Toronto, Toronto, Canada.
St Michael's Hospital, Toronto, Canada.
Bone Joint J. 2020 Sep;102-B(9):1128-1135. doi: 10.1302/0301-620X.102B9.BJJ-2019-1742.R1.
The rate of dislocation when traditional single bearing implants are used in revision total hip arthroplasty (THA) has been reported to be between 8% and 10%. The use of dual mobility bearings can reduce this risk to between 0.5% and 2%. Dual mobility bearings are more expensive, and it is not clear if the additional clinical benefits constitute value for money for the payers. We aimed to estimate the cost-effectiveness of dual mobility compared with single bearings for patients undergoing revision THA.
We developed a Markov model to estimate the expected cost and benefits of dual mobility compared with single bearing implants in patients undergoing revision THA. The rates of revision and further revision were calculated from the National Joint Registry of England and Wales, while rates of transition from one health state to another were estimated from the literature, and the data were stratified by sex and age. Implant and healthcare costs were estimated from local procurement prices and national tariffs. Quality-adjusted life-years (QALYs) were calculated using published utility estimates for patients undergoing THA.
At a minimum five-year follow-up, the use of dual mobility was cost-effective with an estimated incremental cost-effectiveness ratio (ICER) of between £3,006 and £18,745/QALY for patients aged < 55 years and between 64 and 75 years, respectively. For those aged > 75 years dual mobility was only cost-effective if the timeline was beyond seven years. The use of dual mobility bearings was cost-saving for patients aged < 75 years and cost-effective for those aged > 75 years if the time horizon was beyond ten years.
The use of dual mobility bearings is cost-effective compared with single bearings in patients undergoing revision THA. The younger the patient is, the more likely it is that a dual mobility bearing can be more cost-effective and even cost-saving. The results are affected by the time horizon and cost of bearings for those aged > 75 years. For patients aged > 75 years, the surgeon must decide whether the use of a dual mobility bearing is a viable economic and clinical option. Cite this article: 2020;102-B(9):1128-1135.
传统单轴承假体在翻修全髋关节置换术（THA）中的脱位率报告为 8%至 10%。使用双动轴承可将此风险降低至 0.5%至 2%。双动轴承更昂贵，并且尚不清楚额外的临床益处是否对付款人具有成本效益。我们旨在评估与单轴承相比，双动轴承在接受翻修 THA 的患者中的成本效益。
我们开发了一个马尔可夫模型，以估算与接受翻修 THA 的患者中单轴承植入物相比，双动轴承的预期成本和效益。从英国国家联合登记处计算翻修和进一步翻修的比率，而从文献中估计从一种健康状态到另一种健康状态的转移率，并按性别和年龄对数据进行分层。从当地采购价格和国家关税估算植入物和医疗保健成本。使用接受 THA 的患者发表的效用估计值计算质量调整生命年（QALY）。
在至少五年的随访中，对于年龄<55 岁和 64 至 75 岁的患者，使用双动轴承的增量成本效益比（ICER）分别为 3006 英镑至 18745 英镑/QALY，具有成本效益。对于年龄>75 岁的患者，只有在时间超过七年的情况下，双动轴承才具有成本效益。对于年龄<75 岁的患者，使用双动轴承具有成本节约效果，对于年龄>75 岁的患者，如果时间超过十年，则具有成本效益。
与接受翻修 THA 的患者中单轴承相比，使用双动轴承具有成本效益。患者越年轻，双动轴承越有可能更具成本效益，甚至具有成本节约效果。对于年龄>75 岁的患者，结果受轴承的时间范围和成本的影响。对于年龄>75 岁的患者，外科医生必须决定使用双动轴承是否是一种可行的经济和临床选择。
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