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Can choices between alternative hip prostheses be evidence based? a review of the economic evaluation literature

DOI: 10.1186/1478-7547-8-20

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Abstract:

We searched nine medical and economics electronic databases. 3,270 studies were initially identified, 17 studies were included in the review. Studies were critically appraised using three separate guidelines.Several methodological problems were identified including a lack of observed long term prosthesis survival data, limited up-to-date and UK based evidence and exclusion of patient and societal perspectives.More clinical trials including long term follow-up and economic evaluation are needed. These should compare the cost-effectiveness of different prostheses with longer-term follow-up and including a wider perspective.About 8 million people in the UK have osteoarthritis (OA) [1]. Patients typically experience chronic pain and loss of physical function with an impact on society of lost productivity and increased burden on domiciliary/informal care. For those with end stage hip disease, total hip replacement (THR) surgery offers the only effective treatment. Over 70,000 THR operations were carried out in England and Wales in 2008/9 [2], with the number almost doubling in the last decade. As the population continues to age demand for this type of surgery will increase, with significant implications for the health system in terms of the impact on healthcare budgets and service utilisation. Inevitably, healthcare decision makers will need to make decisions that aim to ensure an efficient allocation of resources to THR surgeries, including the availability, timing and configuration of such interventions.The total cost of joint replacement surgery to the National Health Service (NHS), UK in 2000 was approximately £140 million [3], (£172 million in 2008 prices) [4], with the direct hospital costs of each procedure ranging from £488 to £9,905, mean of £4,788 [3](2008 prices). Predicted cost savings of total joint replacement surgery (relative to no surgery) are the reduced costs of arthritis treatment, medication and community care. In this paper we focus on total hip rep

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