Health Technology Assess On Different Kinds Of Artificial Hip Prostheses

Objective The article used the basic principles and methods of Health Technology Assess(HTA) to evaluate five kinds of artificial hip prostheses. Based on that, we could understand different kinds of artificial hip prostheses in Total Hip Arthroplasty (THA) in terms of safety, effectiveness and economy. The optimal artificial hip prostheses under different conditions could be got. Then patients would obtain the best health benefits under the rational economic investment, which was helpful to reduce the disease burden of patients.Methods The data of THA patients during 2012 to 2013 in a top tertiary hospital in Nanjing was collected systematicly, by designing information collection table and accessing to patients’ medical records. The data concluded patients’ basic information, operation, postoperative recovery and hospital fee. The research finally collected 329 cases. After that, the follow-up was conducted to collect the information about hip recovery and life quality of the patients who had been discharged for 2-4 years by the way of telephone interview. The follow-up questionnaire was designed by referring to Harris hip score system and EQ-5D. Eventually,198 cases were collected. Based on different kinds of artificial hip prostheses, objects were divided into 5 groups of A(cemented-metal on polyethylene), B(cemented-ceramic on polyethylene), C(cementless-metal on polyethylene), D(cementless-ceramic on polyethylene) and E(cementless -ceramic on ceramic). The database was established by Excel.2010. Then research made use of SPSS 20.0 statistics software to do statistics analysis. When evaluating economy of five kinds of artificial hip prosthesis, the research utilize the method of cost - effectiveness analysis and cost-utility analysis.Results At the aspect of security, there were no significant differences in operation time, intraoperative blood loss, intraoperative blood transfusion and the rate of postoperative incidence of main complications between five kinds of artificial hip prostheses. At the aspect of effectiveness, there were no significant differences in Harris hip total scores between five kinds of artificial hip prostheses. However, Group A and Group D were better than three others in the scores of living and walking, which had significant differences (P＜0.05). Besides, there were no significant differences in EQ-5D VAS scores between five kinds of artificial hip prostheses. And each dimension also had no significant differences accept the dimension of taking care of onself. At the aspect of economy, the use of different artificial hip prostheses had positive regression relationship with the total hospital cost(y=12546.08+1.06X, P<0.05). Group A and Group D were higher than three others in the cost-effectiveness ratio, which had significant differences (P<0.05). And Group A was lower than Group D in the incremental cost-effectiveness ratio. Besides, Group A and Group D were higher than three others in the cost-utility ratio, which had significant differences (P＜0.05).Conclusions Generally, five kinds of artificial hip prostheses had similar security and effectiveness during perioperation. However, the cementless-ceramic on polyethylene and cementless-ceramic on ceramic prostheses were better to get hip daily function recovery than three others. The use of expensive prostheses was one of the main factors of hospital costs growth. The results of cost-effectiveness analysis and cost-utility analysis between five kinds of artificial hip prostheses were different. The cemented-metal on polyethylene, cemented-ceramic on polyethylene and cementless-metal on polyethylene prostheses had better economy than two others. And the cementless-ceramic on polyethylene prosthesis was better secondly.Suggestion Therefore, the old patients, who were bearing heavy economy burden, were suggested to choosing the cemented-metal on polyethylene, cemented-ceramic on polyethylene or cementless-metal on polyethylene prostheses. The young patients, who were not bearing heavy economy burden, were suggested to choosing the cementless-ceramic on polyethylene prosthesis. Besides, to control the increase of THA patients’ hospital costs and relief their disease burden, some measures should be taken:standardizing the use of artificial hip prostheses, promoting the production of domestic artificial hip prostheses, explore the way of Diseases Related to Groups (DRGs) and so on.