Cost-Effectiveness of Minimally Invasive Total Hip Endoprosthesis Implantation as Compared with the Conventional Approach

Abstract

Objectives: The total hip endoprosthesis implantation is one of the most common surgical procedures of the present day, and surgeons can choose different approaches. The aim of this study is to compare two surgical approaches—the conventional approach and the minimally invasive approach. Methods: Clinical outcomes have been obtained through a literature review of clinical trials. Value engineering methods and multiple-criteria decision methods—namely Saaty’s matrix, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) and the Analytic Hierarchy Process (AHP)—were used for setting the scales of criteria and effects, respectively. The total direct costs per patient were carried out by a systematic cost analysis from the healthcare provider’s perspective. The cost-effectiveness analysis compared the conventional and the minimally invasive approaches. The calculations were completed by a sensitivity analysis. Results: A total of 180 patients were enrolled in the study. The total costs per patient were CZK 57 084 (~EUR 2 243) for the conventional approach, and CZK 54 321 (~EUR 2 134) for the minimally invasive approach. Applying the TOPSIS method, the cost-effectiveness ratio is CZK 125 157 (~EUR 4 917) for the conventional approach, and CZK 88 586 (~EUR 3 480) for the minimally invasive approach. These results were also confirmed using the AHP method, when the C/E ratio is CZK 112 859 (~EUR 4 434) for the conventional approach, and CZK 106 116 (~EUR 4 169) for the minimally invasive approach. Conclusions: The results based on the cost-effectiveness analysis show that the minimally invasive approach to the total hip endoprosthesis implantation is more cost-effective than the conventional approach.