Published Jan 17, 2013

Exeter, UK –Research has shown that primary total hip replacement (THR) has reduced pain and improved mobility and functioning in patients with severe osteoarthritis. Some reports suggest, however, that most eligible patients, women in particular, undergo THR with delay. A study, “Cost-Effectiveness Analysis of Early versus Late Total Hip Replacement in Italy,” published in Value in Health, is the first study to estimate the costs and health benefits of delaying surgery from the health system’s perspective and, incidentally, to offer an explanation for women’s delayed timing of THR relative to men. The model-based assessment demonstrated that delaying THR until the patient’s functional ability was compromised represented a loss in quality of life equivalent to 3.5 years of full health and only saved the Italian National Health System €1,800 (i.e. €534 per QALY gained with early THR) over the course of the patients’ lifetime. Early THR costs more than delayed THR, but resulted in significant benefits in terms of quality of life and only marginally more risk in terms of implant failure late in life. While this study shows that delaying THR is not cost-effective based on Italian cost data, these findings raise the question of whether similar conclusions apply to other health systems. Dr. Ruben Mujica-Mota, PhD, author of the study, states: "This research clearly suggests that the cost savings to national health systems in Europe brought about by delaying THR may not justify the large quality of life losses to patients. It also suggests that early THR would be less cost-effective in women than men if quality of life gains with surgery are proven to erode over time. This is because women would experience more low quality of life years than men due to the fact that women live longer. While this scenario may be consciously motivating doctors to delay surgery in women, more research is needed to measure the long term health benefits of THR."

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