There is little evidence on the cost effectiveness
of different brands of hip prostheses. We compared lifetime cost effectiveness
of frequently used brands within types of prosthesis including cemented
(Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite
Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed)
and hybrid (Exeter V40 Trilogy, Exeter V40 Trident, and CPT Trilogy).
We used data from three linked English national databases to estimate
the lifetime risk of revision, quality-adjusted life years (QALYs)
and cost. . For women with osteoarthritis aged 70 years, the Exeter V40 Elite
Plus Ogee had the lowest risk of revision (5.9% revision risk, 9.0
QALYs) and the CPT Trilogy had the highest QALYs (10.9% revision
risk, 9.3 QALYs). Compared with the Corail Pinnacle (9.3% revision
risk, 9.22 QALYs), the most commonly used brand, and assuming a
willingness-to-pay of £20 000 per QALY gain, the CPT Trilogy is
most cost effective, with an incremental net monetary benefit of £876.
Differences in
Purpose: The purpose of our study is to compare hips to knees in regards to the cost per increase in function, to determine the relationship of economic investment to improved quality of life. Method: During the year 2005, a total of 23 TKA and 41 THA revisions were performed for aseptic mechanical failure. Patients were enrolled prospectively and quality of life questionnaires including the SF-36, WOMAC, Harris Hip Score (HHS), and Knee Society Score (KSS) were collected prior to and following their procedure at two year follow-up. The total cost of the procedure including the hospital, implant, and surgeon fee were implemented in a
Aims. A pragmatic multicentre randomised controlled trial (PROFHER)
was conducted in United Kingdom National Health Service (NHS) hospitals
to evaluate the clinical
Many different designs of total hip arthroplasty
(THA) with varying performance and cost are available. The identification
of those which are the most cost-effective could allow significant
cost-savings. We used an established Markov model to examine the
cost effectiveness of five frequently used categories of THA which differed
according to bearing surface and mode of fixation, using data from
the National Joint Registry for England and Wales. Kaplan–Meier
analyses of rates of revision for men and women were modelled with
parametric distributions. Costs of devices were provided by the
NHS Supply Chain and associated costs were taken from existing studies.
Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and
the probability of a device being cost effective at a willingness
to pay £20 000/QALY were included in the models. The differences in QALYs between different categories of implant
were extremely small (<
0.0039 QALYs for men or women over the
patient’s lifetime) and differences in cost were also marginal (£2500
to £3000 in the same time period). As a result, the probability
of any particular device being the most cost effective was very
sensitive to small, plausible changes in quality of life estimates
and cost. . Our results suggest that available evidence does not support
recommending a particular device on
Background. Collagenase represents a novel non-surgical treatment for Dupuytrens disease. Xiapex (Injectable collagenase, Pfizer pharmaceuticals) was recently approved by the MHRA for clinical use. The main objective of this study was to assess the proportion of patients with Dupuytrens disease that are suitable for treatment with collagenase and the financial implications of its introduction. Methods. All new patients diagnosed with Dupuytrens disease over a three month period (Sept-Nov) were enrolled into study. Patients were assessed in clinic by a senior surgeon. All patients with a palpable Dupuytrens cord without significant skin tethering were offered collagenase. Comparisons were made with the corresponding quarter in the previous 2 years. Management trends were compared over the three years (2009–11) to identify the impact of collagenase.
Economic evaluation of surgical procedures is necessary in view of emerging, often more expensive newer techniques and the budget constraints in an increasingly cost conscious NHS. The purpose of the study was to compare the
To audit and assess the
We present an economic evaluation using data
from the Distal Radius Acute Fracture Fixation Trial (DRAFFT) to compare
the relative
Objectives. To assess the clinical and cost-effectiveness of a virtual fracture clinic (VFC) model, and supplement the literature regarding this service as recommended by The National Institute for Health and Care Excellence (NICE) and the British Orthopaedic Association (BOA). Methods. This was a retrospective study including all patients (17 116) referred to fracture clinics in a London District General Hospital from May 2013 to April 2016, using hospital-level data. We used interrupted time series analysis with segmented regression, and direct before-and-after comparison, to study the impact of VFCs introduced in December 2014 on six clinical parameters and on local Clinical Commissioning Group (CCG) spend. Student’s t-tests were used for direct comparison, whilst segmented regression was employed for projection analysis. Results. There were statistically significant reductions in numbers of new patients seen face-to-face (140.4, . sd. 39.6 versus 461.6, . sd. 61.63, p < 0.0001), days to first orthopaedic review (5.2, . sd. 0.66 versus 10.9, . sd. 1.5, p < 0.0001), discharges (33.5, . sd. 3.66 versus 129.2, . sd. 7.36, p < 0.0001) and non-attendees (14.82, . sd. 1.48 versus 60.47, . sd. 2.68, p < 0.0001), in addition to a statistically significant increase in number of patients seen within 72-hours (46.4% 3873 of 8345 versus 5.1% 447 of 8771, p < 0.0001). There was a non-significant increase in consultation time of 1 minute 9 seconds (14 minutes 53 seconds . sd. 106 seconds versus 13 minutes 44 seconds . sd. 128 seconds, p = 0.0878). VFC saved the local CCG £67 385.67 in the first year and is set to save £129 885.67 annually thereafter. Conclusions. We have shown VFCs are clinically and cost-effective, with improvement across several clinical performance parameters and substantial financial savings for CCGs. To our knowledge this is the largest study addressing clinical practice implications of VFCs in England, using robust methodology to adjust for pre-existing trends. Further studies are required to appreciate whether our results are reproducible with local variations in the VFC model and payment tariffs. Cite this article: A. McKirdy, A. M. Imbuldeniya. The clinical and
Aims: To investigate whether blood transfusion practice in primary total knee replacement (TKR) was being managed appropriately, and to assess the
Introduction: Common pathologies seen in hand clinics include Dupuytren’s contracture, ganglia and trigger digits. Some patients can be treated in the out patient department by percutaneous fasciotomy, aspiration, or percutaneous A1 pulley release. The effectiveness and safety of these procedures has been documented in the literature. There are no studies investigating the
Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities. A five-year prospective registry study investigating every live birth in the study’s catchment area (n = 27,731), all of whom underwent screening for risk factors and examination at the newborn and six- to eight-week neonatal examination and review. DDH was diagnosed using ultrasonography and the Graf classification system, defined as grade IIb or above or rapidly regressing IIa disease (≥4o at four weeks follow-up). Multivariate odds ratios were calculated to establish significant association, and risk differences were calculated to provide quantifiable risk increase with DDH, positive predictive value was used as a measure of predictive efficacy. The cost-effectiveness of using these risk factors to predict DDH was evaluated using NHS tariffs (January 2021).Aims
Methods
We present a retrospective study of comparision between two types of aritifical boen graft substitues. There is an overwhelming marketting drive on part of companies to sell alternative bone grafts/BMP. We in this study compae two such producsts and their
Patellofemoral arthroplasty (PFA) has experienced significant
improvements in implant survivorship with second generation designs.
This has renewed interest in PFA as an alternative to total knee
arthroplasty (TKA) for younger active patients with isolated patellofemoral
osteoarthritis (PF OA). We analysed the cost-effectiveness of PFA We used a Markov transition state model to compare cost-effectiveness
between PFA and TKA. Simulated patients were aged 60 (base case)
and 50 years. Lifetime costs (2015 United States dollars), quality-adjusted
life year (QALY) gains and incremental cost-effectiveness ratio
(ICER) were calculated from a healthcare payer perspective. Annual rates
of revision were derived from the National Joint Registry for England,
Wales, Northern Ireland and the Isle of Man. Deterministic and probabilistic
sensitivity analysis was performed for all parameters against a
$50 000/QALY willingness to pay. Aims
Patients and Methods
56 patients fulfilled the criteria and 50 patients were included in the study between September 2006 – May 2007. Male/female ratio was 18: 32. Mean age was 66.2 years. Procedure included 33 total knees, 13 bilateral and 4 revision knee replacements.
Prior to our study the expenditure on allogenic blood transfusion was £13,230. The estimated cost of using the re-infusion system was £6230 A saving of £ 7500 was achieved as a result of using the drain in the “at risk” patient.
Computer navigation in total joint arthroplasty has been shown to be effective in improving the radiographic outcome in patients undergoing both hip and knee arthroplasty. However, critics have argued that the required capital equipment and added time to perform the procedure is cost prohibitive. To test this hypothesis, we compared our hospital discharge experience with computer navigation to national standards published by the Agency for Healthcare Research and Quality for the years 2004 and 2005 In the AHRQ database the average length of stay for DRG 209 in 2004 and 2005 respectively, in the Midwest region was 4.6 days and 4.3 days, with a mean charge of $27,403 and $27,948, with only 40% and 45%, of patients discharged to home with or without home health care. In 2004 and 2005, the senior author performed 125 and 117 Medicare primary hip and knee replacements, respectively, with computer navigation with a mean length of stay of 2.9 days and 2.8 days, with charges of $22,134 and $24,612, and 63% and 71% discharged to home. On a pure charge basis, the senior author experience a decreased overall charge compared to published data. Even if the entire cost of the navigation system in our system $204,000 was spread equally over only the Medicare patients over the two year period, the additional $842/case still results in a case charge below published data. Based on the senior author’s experience with hospitalization cost, length of stay and discharge disposition, computer navigation in total joint replacement is not associated with an increased cost/case and may result in dramatically lower indirect costs due to shorter length of stay and increased number of discharges to home compared to published regional Medicare discharge data.
The South Wales Air ambulance is a charity-funded helicopter service that started functioning on 1 April 2001. There are 10 staff involved in the running of the service, including pilot and paramedics. The territory covered is the South and Mid-Wales regions. The service costs on average £500 per flight and the net cost per year is approximately £750,000. A retrospective study was performed to evaluate the extent and appropriateness of the air-ambulance call-outs over a 12-month period. The guidelines for call-out are based on medical and non-medical criteria. During this period the helicopter made 315 sorties. On 159 occasions the helicopter was stood down once airborne or following landing at the scene. £80,000 has been spent on non-patient -carrying call-outs. Of the 156 patient-carrying sorties 70% were transferred to Mor-riston Hospital, Swansea. 67% of these patients were categorised as trauma patients. Transfer distance averaged just 15 miles (range 2.6-41.2 miles). The majority of trauma cases were categorised as spinal soft tissue injuries or soft tissue injuries. 52% of patients were discharged by A&
E staff without requiring orthopaedic assessment. 59% of trauma transfers were deemed to be inappropriate for helicopter transfer by the senior author. Our study concludes that the air-ambulance is used inappropriately in at least 50% of the call-outs. The call-out criteria require amending and should place more emphasis on pick-up location rather than the nature of the casualty. It is not used cost effectively and is not always clinically effective.
Physical therapy(PT) is an integral component in the management of musculoskeletal conditions. On the other hand, there have been few reports exclusively dedicated to studying PT interventions on the same day of total hip arthroplasty(THA). In this study, we investigate the role of rehabilitation in the early postoperative period on length of stay (LOS), total medical cost, and physical recovery following total hip arthroplasty. A prospective cohort study was carried out 104 consecutive patients who underwent 107 primary THA performed by two surgeons. Data were gathered on all patients who underwent operative management from June2016 to June 2017. Institutional review board approval was obtained before performing this study. Patient demographic, physical, and clinical dates were collected for all patients, including age, gender, body mass index (BMI), diagnosis, Japan Orthopedic Association (JOA) hip score, Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire (JHEQ) score, 3min walk test, and Timed up and go (TUG) test. The patient population consisted of 5men and 99women, with an average age of 66.0 years (range, 50–84 years). There were no statistically significant differences between patients who did and did not receive PT with regard to demographic, medical, and surgical data, including gender, age, BMI, JOA hip score, JHEQ score, preoperative 3min walk test, preoperative TUG test(Table 1). All patients underwent direct anterior approach THA through navigation system. Postoperative day (POD) 0 was defined as the same day of surgery. There were no standardized criteria by which patients were selected for participation in rehabilitation with physical therapists. Patient selection for POD 0 rehabilitation was based on the end of surgery time. For instance, when the end of surgery time was in the forenoon, the patients were received POD 0 PT. In contrast, patients who ended operation in the afternoon were classified POD 1 PT. Rehabilitation protocol was adjusted based on surgical approach, and all patients were weight bearing as tolerated. TUG test and 3min walk test was done by a physiotherapist on the seventh day postoperatively.INTRODUCTION
METHODS
We completed a retrospective case study of 66 consecutive isolated closed 5th metacarpal neck fractures that presented to our Hospital between September 2009 and March 2010. Their management was established by referring to outpatient letters and A&E notes. The aim of the study was to establish if it would be more efficient and cost effective for these patients to be managed in A&E review clinic without compromising patient care. Of these 66 patients, 56 were males and the mean age was 26 years (12–88 years). Four fractures were not followed up at our Trust, six did not attend their outpatient appointment, one did not require follow up. Of the remaining 55, reviewed at a fracture clinic, all but two were managed conservatively, with 47% requiring one outpatient appointment only. The cost of a new patient Orthopaedic outpatient appointment is £180 with subsequent follow up appointments costing £80 per visit, in contrast to an A&E review clinic appointment at a cost of £60. In view of the small percentage in need of surgical intervention: we highlight the possibility for these patients to be managed solely in the A&E department with a management plan made at the A&E review clinic with an option to refer patients if necessary, and the provision of management guidelines and care quality assurance measures. This, we believe, would maintain care quality for these patients, improve efficiency of fracture clinics and decrease cost. We calculate that even if only all the patients that required one follow up appointment could have been managed by A&E alone then the saving to the local health commissioning body over a six month period from within our trust alone, would have been £3000, which across all trusts providing acute trauma services within the NHS would amount to a substantial saving nationwide.