ARE ELECTIVE ORTHOPAEDIC SURGICAL PROCEDURES IN PATIENTS WITH INFLAMMATORY ARTHROPATHIES COST-EFFECTIVE?

Background: The newest treatments of RA and related diseases are improving the health state of the patients, but the costs are rising. 1 A cost-effective use of resources implies that the treatment which gives the highest expected health gain per unit of cost should be prioritized 2.The Norwegian Directorate of Health has indicated that a gained QALY valued to be equivalent to approximately $77,600 (NOK 500,000) 3 is cost effective treatment. Orthopaedic surgical treatment of patients with inflammatory arthropathies is an option in treating patients with inflammatory arthropathies and economic evaluation is necessary to consider the cost-effectiveness of the interventions. Objectives: To examine the cost-effectiveness of surgical interventions in patients with inflammatory arthropathies. Secondly, to compare the cost-effectiveness of replacement versus non-replacement surgical interventions. Methods: In total, 248 patients (mean (SD) age 57 (13) years, 77% female) with inflammatory arthropathies underwent orthopaedic surgical treatment and responded to mail surveys at baseline and during follow-up (3, 6, 9 and 12 months). The questionnaires included the quality-of-life (utility) scores EQ-5D and SF-6D. The health benefit from surgery was subsequently translated into Quality Adjusted Life Years (QALYs). The direct treatment costs the first year were, for each patient, derived from the hospital's cost per patient accounting system (KOSPA). The cost per QALY was estimated and future costs and benefits were discounted at 4%. Results: Improvement in utility at one year follow-up was 0.10 with EQ-5D (p<0.001) and 0.03 with SF-6D (p<0.001). The estimated 10-year cost per QALY gained was $6,226 for hip replacement surgery ($23,527 using SF-6D). All replacement procedures had a 10-year cost pr. QALY of $13,255 (SF-6D $61,522). The five-year cost per QALY was $23,335 for non-replacement surgical procedures measured by EQ-5D (SF-6D: $92,986). Conclusion: Elective orthopaedic surgery in patients with inflammatory arthropathies was cost-effective when measured with EQ-5D, and some procedures were also cost-effective when SF-6D was used in the economic evaluations. Replacement surgery and especially hip replacement surgery are more cost-effective procedures than the non-replacement procedures. References: 1. Tan MC, Regier DA, Esdaile JM, Lynd LD, Anis AH, Marra CA. Health economic evaluation: a primer for the practicing rheumatologist. Arthritis Rheum 2006; 55(4):648-656. 2. NOU 18. Prioriteringer på ny (Ranking of priorities again). 1997. Statens forvaltningstjeneste (Royal Commission). Ref Type: Report 3. Sælensminde K. Helseeffekter i samfunnsøkonomiske analyser. IS-1435. 2007. Oslo, Social- og helsedirektoratet. Ref Type: Report Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 68, supplement 3, year 2009, page 116Session: EFORTEULAR Session: When should we refer patients for surgery? (Oral Presentations )