Anterior-Based Muscle-Sparing Approach (ABLE) Is Cost-Effective When Compared with Posterolateral and Direct Anterior Approaches for Total Hip Arthroplasties

OBJECTIVES: Research relating to Total Hip Arthroplasties (THAs) has found that the anterior-based muscle-sparing approach, also known as the ABLE approach, improves both intraoperative and postoperative outcomes when compared to other THA approaches. This study compares the costs and outcomes related with ABLE and standard of care (SOC) to determine their relative cost-effectiveness from a US payor perspective. In the base case analysis, SOC is defined as 60% Direct Anterior Approach (DAA) and 40% Posterolateral Approach (PA) THAs.

METHODS: A decision-analytic model in the form of a decision tree was utilized to estimate intraoperative outcomes (i.e., length of procedure, length of stay (LOS), and transfusion rates) and 90-day postoperative complications (deep infection, periprosthetic fracture, and dislocation). Data relating to postoperative complications, intraoperative outcomes, and costs (uplifted to 2023 USD) were obtained from the literature. Model results were presented as incremental costs and complications avoided using a willingness-to-pay threshold of $100,000. We conducted both One-Way Sensitivity Analysis (OWSA), varying each parameter individually within a specific range, and Probabilistic Sensitivity Analysis (PSA) where parameters were varied simultaneously. In scenario analysis, ABLE was also compared to PA and DAA individually.

RESULTS: ABLE THA was found to dominate SOC THA over a 90-day time horizon as it decreased major complications by 0.00186 and cost by $3,863 per patient. The PSA found ABLE to be cost-saving and cost-effective in approximately 98.29% and 100% of 10,000 iterations, respectively. Comparing ABLE with only PA procedures increased cost saving per patient to $4,778 while it decreased to $3,253 when comparing ABLE to only DAA procedures. Length of procedure, LOS, and discharge disposition were the main cost drivers.

CONCLUSIONS: This analysis suggests that, where appropriate, ABLE should be considered a cost-effective THA technique when compared to PA and DAA, which may provide an opportunity for cost-savings in the short-term.