Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study

Objectives To assess how costs and quality of life (measured by EuroQoL-5 Dimensions (EQ-5D)) before and after total hip replacement (THR) and total knee replacement (TKR) vary with age, gender and preoperative Oxford hip score (OHS) and Oxford knee score (OKS). Design Regression analyses using prospectively collected data from clinical trials, cohort studies and administrative data bases. Setting UK secondary care. Participants Men and women undergoing primary THR or TKR. The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years. The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years. The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year. Outcome measures EQ-5D-3L quality of life before and after surgery, costs of primary arthroplasty, costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement. Results Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile. The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10. However, postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44. In contrast, costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS. For example, costs of hospital readmissions within 12 months after primary THR/TKR were £740/£888 for patients at the 5th percentile compared with £314/£404 at the 95th percentile of the OHS/OKS distribution. Conclusions Our findings suggest that costs and quality of life associated with total joint replacement vary systematically with preoperative symptoms measured by OHS/OKS.

[1]  Madhu Mazumdar,et al.  Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative , 2017, British Medical Journal.

[2]  Pia Hardelid,et al.  Data Resource Profile: Hospital Episode Statistics Admitted Patient Care (HES APC) , 2017, International journal of epidemiology.

[3]  S. Noble,et al.  Local anaesthetic wound infiltration in addition to standard anaesthetic regimen in total hip and knee replacement: long-term cost-effectiveness analyses alongside the APEX randomised controlled trials , 2015, BMC Medicine.

[4]  Katie Brittain,et al.  The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study. , 2014, Health technology assessment.

[5]  M. Eccles,et al.  Selective decontamination of the digestive tract in critically ill patients treated in intensive care units: a mixed-methods feasibility study (the SuDDICU study). , 2014, Health technology assessment.

[6]  Ray Fitzpatrick,et al.  A randomised controlled trial of the clinical effectiveness and cost-effectiveness of different knee prostheses: the Knee Arthroplasty Trial (KAT). , 2014, Health technology assessment.

[7]  C. Cooper,et al.  Body mass index is not a clinically meaningful predictor of patient reported outcomes of primary hip replacement surgery: prospective cohort study. , 2014, Osteoarthritis and cartilage.

[8]  David Parkin,et al.  Assessing the performance of the EQ-VAS in the NHS PROMs programme , 2012, Quality of Life Research.

[9]  C. Cooper,et al.  The association of patient characteristics and surgical variables on symptoms of pain and function over 5 years following primary hip-replacement surgery: a prospective cohort study , 2013, BMJ Open.

[10]  D J Beard,et al.  The effects of age on patient-reported outcome measures in total knee replacements. , 2013, The bone & joint journal.

[11]  P. Dieppe,et al.  Assessing function in patients undergoing joint replacement: a study protocol for a cohort study , 2012, BMC Musculoskeletal Disorders.

[12]  R. Fordham,et al.  The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study , 2012, BMJ Open.

[13]  R. Fitzpatrick,et al.  Rationing of total knee replacement: a cost-effectiveness analysis on a large trial data set , 2012, BMJ Open.

[14]  N. Mahomed,et al.  Predicting the Longer-term Outcomes of Total Hip Replacement , 2010, The Journal of Rheumatology.

[15]  C. Cooper,et al.  Patient‐reported outcomes one year after primary hip replacement in a European Collaborative Cohort , 2010, Arthritis care & research.

[16]  Rajiv Gandhi,et al.  Predicting the longer term outcomes of total knee arthroplasty. , 2010, The Knee.

[17]  K. Bozic.  Cost-effectiveness of Total Knee Arthroplasty in the United States—Invited Commentary , 2009 .

[18]  A David Paltiel,et al.  Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. , 2009, Archives of internal medicine.

[19]  D Coggon,et al.  Long-term outcome following total knee arthroplasty: a controlled longitudinal study , 2008, Annals of the rheumatic diseases.

[20]  A. Carr,et al.  Questionnaire on the perceptions of patients about total knee replacement. , 1998, The Journal of bone and joint surgery. British volume.

[21]  P. Dolan,et al.  Modeling valuations for EuroQol health states. , 1997, Medical care.

[22]  H. Sintonen,et al.  Costs and Cost-Effectiveness in Hip and Knee Replacements: A Prospective Study , 1997, International Journal of Technology Assessment in Health Care.

[23]  A. Carr,et al.  Questionnaire on the perceptions of patients about total hip replacement. , 1996, The Journal of bone and joint surgery. British volume.