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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

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
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.

costs, hip replacement, knee replacement, oxford hip score, oxford knee score, quality-of-life
2044-6055
Eibich, Peter
8a561eee-e166-46f9-b60f-97c35f61167c
Dakin, Helen A.
807a9720-bfa0-46c6-a315-e1295982ff9c
Price, Andrew James
3e1f1c5b-12d0-4173-995e-d9bba77b5562
Beard, David
7bb0be51-1b39-4c53-b0c1-9d9e8c9df7e6
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f
Gray, Alastair M.
3d36006e-b93b-459b-bf20-b413b4528a84
Eibich, Peter
8a561eee-e166-46f9-b60f-97c35f61167c
Dakin, Helen A.
807a9720-bfa0-46c6-a315-e1295982ff9c
Price, Andrew James
3e1f1c5b-12d0-4173-995e-d9bba77b5562
Beard, David
7bb0be51-1b39-4c53-b0c1-9d9e8c9df7e6
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f
Gray, Alastair M.
3d36006e-b93b-459b-bf20-b413b4528a84

Eibich, Peter, Dakin, Helen A., Price, Andrew James, Beard, David, Arden, Nigel K. and Gray, Alastair M. (2018) 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. BMJ Open, 8 (4), [e019477]. (doi:10.1136/bmjopen-2017-019477).

Record type: Article

Abstract

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.

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Accepted/In Press date: 7 February 2018
e-pub ahead of print date: 10 April 2018
Published date: April 2018
Keywords: costs, hip replacement, knee replacement, oxford hip score, oxford knee score, quality-of-life

Identifiers

Local EPrints ID: 427007
URI: http://eprints.soton.ac.uk/id/eprint/427007
ISSN: 2044-6055
PURE UUID: b578baa7-edbd-4909-b675-5b23d35baf95

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Date deposited: 20 Dec 2018 17:30
Last modified: 05 Jun 2024 18:54

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Contributors

Author: Peter Eibich
Author: Helen A. Dakin
Author: Andrew James Price
Author: David Beard
Author: Nigel K. Arden
Author: Alastair M. Gray

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