Are Different Generations of Ceramic-on-Ceramic Implants More Cost-Effective Than Metal-on-Polyethylene Implants in Primary Total Hip Arthroplasty?

Speaker(s)

Ku LJ1, Huang Y1, Tai TW2, Hsu SH1, Ling D1, Wang JD1
1National Cheng Kung University College of Medicine, Tainan, TNN, Taiwan, 2National Cheng Kung University Hospital, Tainan, TNN, Taiwan

Presentation Documents

OBJECTIVES:

Metal-on-Polyethylene (MoP) in total hip arthroplasty implants are covered by the National Health Insurance in Taiwan, whereas Ceramic-on-Ceramic (CoC) implants require a copayment for the device. Despite being twice as expensive as third-generation CoC implants (3rd-CoC), the latest fourth-generation CoC implants (4th-CoC) have gained preference recently. This study examines the cost- effectiveness of a choice between the 3rd- and 4th-CoC implants versus the MoP in primary total hip arthroplasty (THA).

METHODS:

This study included patients aged 50 years and above undergoing initial THA for osteoarthritis (OA) from 2009 to 2019 in Taiwan. One-to-one matching was used to create comparable groups of different implant pairs (3rd-CoC vs. MoP and 4th-CoC vs. MoP). Generalized linear models (GLMs) were used for assessing total healthcare costs, and Cox models were employed for analyzing three clinical outcomes including revision, postoperative complications, and 90-day medical complications. Hazard rates and cost differences within the matched pairs were examined to calculate the incremental cost-effectiveness ratio (ICER).

RESULTS:

The study cohort comprised 15,233 patients undergoing primary THA before matching: MoP(66.7%), the 3rd CoC(10.3%) and the 4th CoC(23.0%). Compared to matched MoP, the 3rd-CoC showed lower hazards in revision (aHR=0.53, 95% CI 0.34-0.85, P = .01) and in postoperative complications (aHR=0.69, 95% CI 0.49-0.99, P = .04). The 4th-CoC group demonstrated lower hazards of 90-day medical complications (aHR=0.29, 95% CI 0.15-0.54, P < .01). For the 3rd CoC, the ICER for a 1% reduction in revision rates was US$361 and US$363 for a 1% reduction in postoperative complications rates compared with the MoP. For the 4th CoC, the ICER was US$2,446 for a 1% reduction in 90-day medical complication rates compared with the MoP.

CONCLUSIONS:

Real-word data in Taiwan demonstrated that using CoC implants in THA can reduce the hazards of adverse outcomes post surgery, albeit at higher costs.

Code

EE614

Topic

Economic Evaluation, Medical Technologies, Study Approaches

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Medical Devices

Disease

Medical Devices, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)