Paper #11 - ISHA Annual Scientific Meeting 2016

The Effects of Arthroscopy for Symptomatic Femoroacetabular Impingement on Quality of Life and Economic Outcomes

Richard C. Mather, MD, MBA, Durham, NC UNITED STATES
Shane J. Nho, MD, MS, Chicago, IL UNITED STATES
Andrew Federer, MD, Durham, NC UNITED STATES
Jennifer Nguyen, MPP, Durham, NC UNITED STATES
Josh D. Saavoss, BA, Durham, NC UNITED STATES
Michael Jonathan Salata, MD, Cleveland, OH UNITED STATES
Marc J. Philippon, MD, Vail, CO UNITED STATES
Asheesh Bedi, MD, Ann Arbor, MI UNITED STATES
Christopher Michael Larson, MD, Edina, MN UNITED STATES
Thomas Byrd, MD, Durham, NC UNITED STATES
Lane Koenig, PhD, Durham, NC UNITED STATES

Duke University, Durham, North Carolina, UNITED STATES

FDA Status Not Applicable

Summary: This study examines the cost effectiveness of treatment of symptomatic femoroacetabular impingement through an analysis of the direct and indirect costs associated with hip arthroscopy and non-operative treatment.

BACKGROUND: The diagnosis and treatment of femoroacetabular impingement (FAI) has increased steadily within the last decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. There is increasing knowledge of the effect on productivity and employment of musculoskeletal diseases such as ACL and rotator cuff tears, knee osteoarthritis and lumbar disc herniation, but little is known about the economic impact of symptomatic FAI and arthroscopic treatment. The purpose of this study was to examine the societal and economic impact of symptomatic FAI and subsequent hip arthroscopy in patients under age 50.

METHODS: A Markov decision model was constructed for a cost-utility analysis of hip arthroscopy and non-operative treatment. Outcomes probabilities and utilities (quality adjusted life years) were taken from the literature. Direct costs associated with FAI treatment were calculated using the Humana private payer database (Pearl Diver Inc, West Conshohocken, PA), while indirect costs were measured in a cohort of 106 patients under age 50 with classic symptomatic FAI using the Musculoskeleltal Value Model. The MSK value model is a validated model built on the National health Interview Survey that predicts expected earnings for specific functional states. The indirect economic benefits of hip arthroscopy were inferred using regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. Principal outcome measures were average incremental cost and effectiveness and net health benefits. One, two and three way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis was used to evaluate the impact of uncertainty in the model assumptions. The analysis was performed in accordance with the Panel on Cost Effectiveness Analysis in Health and Medicine.

RESULTS: Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity (MAP) of $8,968 following surgery. Cost effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy compared to non-operative treatment. Hip arthroscopy also conferred a gain of 2.03 QALY over this time period. The mean cost for hip arthroscopy was estimated at $23,065 ± $10,286, and the mean cost of non-operative treatment was estimated at $90,559 ± $29,014. In 99% of trials, hip arthroscopy was recognized as the preferred cost-effective strategy. The model findings were extremely robust when tested with sensitivity analysis.

DISCUSSION: Symptomatic FAI creates a substantial economic burden on society that may be reduced with hip arthroscopy. The economic disability of symptomatic FAI is greater than rotator cuff or ACL tears and is comparable to knee OA. Hip arthroscopy confers greater economic benefit than total knee arthroplasty and over twice the economic benefit of ACL reconstruction. Further studies are needed to confirm these results in a larger population and determine economic impact in subgroups experiencing less clinical benefit with arthroscopy, such as those over age 50 and those with existing degenerative joint disease.