Cost-Effectiveness Analysis of Total Hip Arthroplasty with Minimally Invasive Surgery

Background: Total hip arthroplasty (THA) is the primary late-stage treatment for many degenerative hip diseases, including osteoarthritis, avascular necrosis, and rheumatoid arthritis. In recent decades there has been growing interest in the development of minimally invasive techniques which have revolutionized hip surgery with the objectives of less muscle and soft tissue breakage, reduction of blood loss, and accelerated rehabilitation.

Objectives: The main objective of this study is to evaluate the cost-effectiveness of total hip arthroplasty through anterolateral minimally invasive surgery (MIS) and compare it with the traditional approach.

Methods: A study was conducted to compare traditional and minimally invasive surgical techniques for total hip arthroplasty in a population of 340 patients at two Spanish hospitals during the year 2007. The study was performed in two hospitals: the Virgen de las Nieves University Hospital of Granada and the Serranía de Ronda Hospital. The design of the study was a prospective stochastic cost-effectiveness analysis, where effectiveness data were collected over a one-year period at individual patient levels and costs were gathered from the analytical accounting system of Virgen de las Nieves University Hospital. Effectiveness was measured in functional terms (clinical) and self-perceived quality of life (SF-12 survey) during the first 6 postoperative weeks, the period during which the most dramatic benefits of minimally invasive total hip arthroplasty were expected.

Results: After 6 postoperative weeks, in comparison with the conventional technique, a pattern in improvements for MIS was observed for length of hospital stay (hospitalization time was 4.97 days shorter); for operative time (an average of 83.3 minutes for MIS patients and 97.8 minutes for the control group); and for average length of skin incision (9.83 cm. for the MIS group and 16.2 cm. for the control group). The total cost of THA with MIS was lower (4,519.19 €) than the cost of traditional hip replacement (6,722.46 €). Incremental effectiveness value in terms of quality of life was 0.11 points in the SF-12 survey for MIS. The cost-effectiveness analysis reveals a strong dominance of MIS versus traditional THA, with lower costs and better outcomes.

Conclusions: The study showed that the minimally invasive technique reduces inpatient resource utilization and improves self-perceived quality of life of patients compared with the traditional approach. The more beneficial incremental effectiveness ratio of MIS versus traditional THA supports the recommendation for expanded use of minimally invasive surgery.