Cost is a factor in the choice of prosthetic components in joint replacement.
For a given performance, the least expensive components are the most cost-effective.
When evaluating a new prosthesis with an unknown outcome, the use of an economic model allows estimation of potential cost-effectiveness.
We used published data for the survival of cemented total hip replacements from Sweden, and cost and demographic information from New South Wales, Australia, in such a model.
In young active total hip recipients a new prosthetic design which offered a 90% improvement in survivorship over 15 years and a 15% reduction in the cost of revision surgery, could be sold at a price of 2 to 2.5 times that of conventional cemented components such as the Charnley Low Friction Arthroplasty and still be cost-effective.
Using more likely estimates of the improved performance of new technology, however, the upper limit of cost-effectiveness is an increase of 1.5 to 1. Only a very small increase in the cost of a prosthesis could ever be justified for older patients of either sex.
Most of the potential benefits of a better level of survivorship appear towards the end of the 15-year period.
The results of modelling may be incorporated in clinical trial design.
Given the known performance of some well-established and relatively inexpensive designs of prostheses, very large randomised studies would be required to prove an improvement in performance.
Mots-clés Pascal : Economie santé, Royaume Uni, Europe, Modèle, Analyse coût efficacité, Prothèse, Articulation, Evaluation, Hanche, Homme, Etude comparative, Matériel technique, Chirurgie, Système ostéoarticulaire pathologie
Mots-clés Pascal anglais : Health economy, United Kingdom, Europe, Models, Cost efficiency analysis, Prosthesis, Joint, Evaluation, Hip, Human, Comparative study, Technical equipment, Surgery, Diseases of the osteoarticular system
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0426295
Code Inist : 002B25I. Création : 01/03/1996.