OBJECTIVES

To identify the state of the literature evaluating the Health Economics of total hip arthroplasty.

METHODS

We conducted a systematic review of published Health Economics Analyses (HEA) of total hip arthroplasty (THA). We examined published papers which included HEA from the PubMed, US National Library of Medicine National Institutes of Health, excluding case reports, editorial, guideline, letter, review and comment. We focused on HEA pertaining to THA, which included joint prosthesis, arthroplasty and artificial joint replacement, published between 2000 and 2018. Our search strategy further specified inclusion of incremental cost-effectiveness ratios, perspective of the analysis, time horizon, discounting rates, utility assessment, and sensitivity analysis.

RESULTS

We identified 279 published HEA in THA. We excluded papers evaluating HEA of: pre- or postoperative treatment strategies, rehabilitation, program, tool, adverse event prophylaxis (infection, hemostasis, blood management and thromboembolism), or non-elective total joint arthroplasty (for example, THA as use of knotless suture, arthroplasty etc.). After applying our inclusion/exclusion criteria there were 35 publications remaining (28 with the elective total joint arthroplasty and 3 with the use of navigation/computer-assist). In the elective total joint arthroplasty, four studies considered cost-effectiveness ratios (CERs) for standard THA comparing to metal on metal, three studies considered CERs for standard THA comparing to dual-mobility acetabular components, and three studies considered CERs for uncemented cup comparing to cemented cup. Five studies applied non-replacement surgical procedures or pre-operations as comparator and seven studies included evaluations using some sort of cost-effectiveness threshold.

CONCLUSIONS

Dual-mobility acetabular components are found to be highly cost-effective in a number of high quality studies. Further analyses are needed on the cost effectiveness of alternative innovative implant options, navigation/computer-assist and robotic. In Asian countries, future economic evaluations should address the expanding indications of THA using long-term follow-up data such as registry data.