PMID- 27802289 OWN - NLM STAT- MEDLINE DCOM- 20170621 LR - 20220129 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 11 IP - 11 DP - 2016 TI - Has Metal-On-Metal Resurfacing Been a Cost-Effective Intervention for Health Care Providers?-A Registry Based Study. PG - e0165021 LID - 10.1371/journal.pone.0165021 [doi] LID - e0165021 AB - BACKGROUND: Total hip replacement for end stage arthritis of the hip is currently the most common elective surgical procedure. In 2007 about 7.5% of UK implants were metal-on-metal joint resurfacing (MoM RS) procedures. Due to poor revision performance and concerns about metal debris, the use of RS had declined by 2012 to about a 1% share of UK hip procedures. This study estimated the lifetime cost-effectiveness of metal-on-metal resurfacing (RS) procedures versus commonly employed total hip replacement (THR) methods. METHODOLOGY/PRINCIPAL FINDINGS: We performed a cost-utility analysis using a well-established multi-state semi-Markov model from an NHS and personal and social services perspective. We used individual patient data (IPD) from the National Joint Registry (NJR) for England and Wales on RS and THR surgery for osteoarthritis recorded from April 2003 to December 2012. We used flexible parametric modelling of NJR RS data to guide identification of patient subgroups and RS devices which delivered revision rates within the NICE 5% revision rate benchmark at 10 years. RS procedures overall have an estimated revision rate of 13% at 10 years, compared to <4% for most THR devices. New NICE guidance now recommends a revision rate benchmark of <5% at 10 years. 60% of RS implants in men and 2% in women were predicted to be within the revision benchmark. RS devices satisfying the 5% benchmark were unlikely to be cost-effective compared to THR at a standard UK willingness to pay of pound20,000 per quality-adjusted life-year. However, the probability of cost effectiveness was sensitive to small changes in the costs of devices or in quality of life or revision rate estimates. CONCLUSION/SIGNIFICANCE: Our results imply that in most cases RS has not been a cost-effective resource and should probably not be adopted by decision makers concerned with the cost effectiveness of hip replacement, or by patients concerned about the likelihood of revision, regardless of patient age or gender. FAU - Pulikottil-Jacob, Ruth AU - Pulikottil-Jacob R AD - Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. FAU - Connock, Martin AU - Connock M AD - Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. FAU - Kandala, Ngianga-Bakwin AU - Kandala NB AD - Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. AD - Northumbria University, Department of Mathematics, Physics and Electrical Engineering, Faculty of Engineering and Environment, Newcastle upon Tyne, United Kingdom. FAU - Mistry, Hema AU - Mistry H AD - Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. FAU - Grove, Amy AU - Grove A AD - Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. FAU - Freeman, Karoline AU - Freeman K AD - Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. FAU - Costa, Matthew AU - Costa M AD - Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. FAU - Sutcliffe, Paul AU - Sutcliffe P AD - Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. FAU - Clarke, Aileen AU - Clarke A AD - Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom. LA - eng GR - WMCLAHRC-2014-1/DH_/Department of Health/United Kingdom PT - Journal Article DEP - 20161101 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Metals) SB - IM MH - Adult MH - Aged MH - Arthroplasty, Replacement, Hip/economics/methods MH - Cost-Benefit Analysis/*economics MH - England MH - Female MH - Health Personnel/*economics MH - Hip Prosthesis/economics MH - Humans MH - Male MH - Metal-on-Metal Joint Prostheses/*economics MH - Metals MH - Middle Aged MH - Osteoarthritis, Hip/surgery/therapy MH - Prosthesis Design/economics/methods MH - Prosthesis Failure MH - Quality of Life MH - Registries MH - Risk Factors MH - Wales PMC - PMC5089767 COIS- The authors have declared that no competing interests exist. EDAT- 2016/11/02 06:00 MHDA- 2017/06/22 06:00 PMCR- 2016/11/01 CRDT- 2016/11/02 06:00 PHST- 2016/05/13 00:00 [received] PHST- 2016/10/05 00:00 [accepted] PHST- 2016/11/02 06:00 [pubmed] PHST- 2017/06/22 06:00 [medline] PHST- 2016/11/02 06:00 [entrez] PHST- 2016/11/01 00:00 [pmc-release] AID - PONE-D-16-19447 [pii] AID - 10.1371/journal.pone.0165021 [doi] PST - epublish SO - PLoS One. 2016 Nov 1;11(11):e0165021. doi: 10.1371/journal.pone.0165021. eCollection 2016.