Does Combined Hip Arthroscopy-Periacetabular Osteotomy Provide Value? A Cost-Utility Analysis

Purpose Hip arthroscopy plus PAO has been recommended to address the intraarticular pathology. Objective of this research was to conduct a trial-based economic evaluation to assess the cost-effectiveness of PAO plus arthroscopy compared to PAO. Methods A cost-utility analysis based on a randomized controlled trial of 117 patients with hip dysplasia randomized to receive PAO plus arthroscopy or PAO alone. Effectiveness was measured as quality-adjusted life years (QALYs). Costs included procedure costs, hospitalization, and physician fees associated with the surgery. A mixed model was used to estimate difference in costs and QALY and to calculate the incremental cost-effectiveness ratios (ICERs) with 95% confidence intervals (CI). Bootstrapping method was used to characterize statistical uncertainty around the cost-effectiveness estimates. A scenario analysis was conducted accounting for productivity loss (societal perspective) which was measured using the Work Productivity and Activity Impairment Questionnaire. Results Sixty-two patients had PAO plus arthroscopy and 55 patients had PAO alone; mean age: 27. 9 years (SD=8. 14) ; female (84%) ; mean followup 3. 2years. The PAO plus arthroscopy led to an additional cost of C5, 623 (95% CI C4, 154, 7, 093) and reduced QALYs of −0. 02 (95%CI −0. 12, 0. 09). The probability that PAO plus arthroscopy was cost-effective was 0% at the willingness to pay value of 50, 000 per QALY. Accounting for productivity costs, PAO plus arthroscopy was still more costly (5, 255) and less effective (−0. 03). Conclusion PAO plus arthroscopy cost more and did not improve health utility compared to PAO. At a willingness to pay of fifty thousand dollars per QALY the probability of cost effectiveness for the combined procedure was zero. Routine addition of arthroscopy to PAO does not provide value.