INFORMING SURGICAL DECISION-MAKING THROUGH EVIDENCE: A RANDOMIZED TRIAL-BASED COST-UTILITY ANALYSIS OF PERIACETABULAR OSTEOTOMY PLUS ARTHROSCOPY FOR HIP DYSPLASIA
Author(s)
Lisa Masucci, MSc1, Kednapa Thavorn, PhD2.
1The Ottawa Hospital, Ottawa, ON, Canada, 2Ottawa Hospital Research Institute, Ottawa, ON, Canada.
1The Ottawa Hospital, Ottawa, ON, Canada, 2Ottawa Hospital Research Institute, Ottawa, ON, Canada.
OBJECTIVES: A periacetabular osteotomy (PAO) is performed to relieve symptoms of hip dysplasia, improve quality of life, and delay or prevent the need for joint replacement surgery. Although concomitant hip arthroscopy has been recommended to address intra-articular pathology, its added clinical value remains uncertain and may increase healthcare costs. A trial-based economic evaluation was conducted to assess the cost-effectiveness of PAO plus arthroscopy compared with PAO alone over a 2-year time horizon from a publicly funded healthcare system perspective.
METHODS: A cost-utility analysis was conducted alongside a randomized controlled trial involving 117 patients with hip dysplasia. Patients were randomized to receive PAO plus arthroscopy or PAO alone. Effectiveness was measured as quality-adjusted life years (QALYs), derived from the PROMIS-Preference scoring system. Costs included healthcare resource use for the procedure and reoperations. Incremental cost-effectiveness ratios and 95% confidence intervals (CI) were estimated over a range of willingness-to-pay thresholds. Uncertainty around incremental costs and incremental effectiveness was estimated using non-parametric bootstrapping.
RESULTS: Sixty-two patients had PAO plus arthroscopy and 55 patients had PAO alone. The mean age was 27.9 years (SD=8.14) and the majority of patients were female (84%). The PAO plus arthroscopy led to an additional cost of C$5,759 (95% CI C$4,295, $7,223) and reduced QALYs of -0.04 (95% CI -0.14, 0.06). The combined procedure was associated with higher costs and no improvement in health outcomes.
CONCLUSIONS: PAO plus arthroscopy was not found to be a cost-effective option as it was more costly and less effective than PAO alone. These findings provide robust trial-based evidence to guide surgical decision-making and resource allocation, supporting more efficient use of healthcare resources in the management of hip dysplasia.
METHODS: A cost-utility analysis was conducted alongside a randomized controlled trial involving 117 patients with hip dysplasia. Patients were randomized to receive PAO plus arthroscopy or PAO alone. Effectiveness was measured as quality-adjusted life years (QALYs), derived from the PROMIS-Preference scoring system. Costs included healthcare resource use for the procedure and reoperations. Incremental cost-effectiveness ratios and 95% confidence intervals (CI) were estimated over a range of willingness-to-pay thresholds. Uncertainty around incremental costs and incremental effectiveness was estimated using non-parametric bootstrapping.
RESULTS: Sixty-two patients had PAO plus arthroscopy and 55 patients had PAO alone. The mean age was 27.9 years (SD=8.14) and the majority of patients were female (84%). The PAO plus arthroscopy led to an additional cost of C$5,759 (95% CI C$4,295, $7,223) and reduced QALYs of -0.04 (95% CI -0.14, 0.06). The combined procedure was associated with higher costs and no improvement in health outcomes.
CONCLUSIONS: PAO plus arthroscopy was not found to be a cost-effective option as it was more costly and less effective than PAO alone. These findings provide robust trial-based evidence to guide surgical decision-making and resource allocation, supporting more efficient use of healthcare resources in the management of hip dysplasia.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE52
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Surgery