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The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling

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The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery : development and economic modelling. / Price, Andrew; Smith, James; Dakin , H ; Kang, Sujin; Eibich, Peter; Cook, Jonathan; Gray, Alastair; Harris, Kristina; Middleton, Robert; Gibbons, Elizabeth; Benedetto, Elena; Smith, Stephanie; Dawson, Jill; Fitzpatrick, Raymond; Sayers, Adrian; Miller, Laura; Marques, Elsa; Gooberman-Hill, Rachael; Blom, Ashley; Judge, Andrew; Arden, Nigel K; Murray, David; Glyn-Jones, Sion; Barker, Karen; Carr, Andrew; Beard, David.

In: Health Technology Assessment, Vol. 23, No. 32, 01.07.2019, p. 1-216.

Research output: Contribution to journalArticle

Harvard

Price, A, Smith, J, Dakin , H, Kang, S, Eibich, P, Cook, J, Gray, A, Harris, K, Middleton, R, Gibbons, E, Benedetto, E, Smith, S, Dawson, J, Fitzpatrick, R, Sayers, A, Miller, L, Marques, E, Gooberman-Hill, R, Blom, A, Judge, A, Arden, NK, Murray, D, Glyn-Jones, S, Barker, K, Carr, A & Beard, D 2019, 'The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling', Health Technology Assessment, vol. 23, no. 32, pp. 1-216. https://doi.org/10.3310/hta23320, https://doi.org/10.3310/hta23320

APA

Price, A., Smith, J., Dakin , H., Kang, S., Eibich, P., Cook, J., ... Beard, D. (2019). The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling. Health Technology Assessment, 23(32), 1-216. https://doi.org/10.3310/hta23320, https://doi.org/10.3310/hta23320

Vancouver

Author

Price, Andrew ; Smith, James ; Dakin , H ; Kang, Sujin ; Eibich, Peter ; Cook, Jonathan ; Gray, Alastair ; Harris, Kristina ; Middleton, Robert ; Gibbons, Elizabeth ; Benedetto, Elena ; Smith, Stephanie ; Dawson, Jill ; Fitzpatrick, Raymond ; Sayers, Adrian ; Miller, Laura ; Marques, Elsa ; Gooberman-Hill, Rachael ; Blom, Ashley ; Judge, Andrew ; Arden, Nigel K ; Murray, David ; Glyn-Jones, Sion ; Barker, Karen ; Carr, Andrew ; Beard, David. / The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery : development and economic modelling. In: Health Technology Assessment. 2019 ; Vol. 23, No. 32. pp. 1-216.

Bibtex

@article{8063ca2534e24bfbaf16fb030bcc0a89,
title = "The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling",
abstract = "BACKGROUND: There is no good evidence to support the use of patient-reported outcome measures (PROMs) in setting preoperative thresholds for referral for hip and knee replacement surgery. Despite this, the practice is widespread in the NHS. OBJECTIVES/RESEARCH QUESTIONS: Can clinical outcome tools be used to set thresholds for hip or knee replacement? What is the relationship between the choice of threshold and the cost-effectiveness of surgery? METHODS: A systematic review identified PROMs used to assess patients undergoing hip/knee replacement. Their measurement properties were compared and supplemented by analysis of existing data sets. For each candidate score, we calculated the absolute threshold (a preoperative level above which there is no potential for improvement) and relative thresholds (preoperative levels above which individuals are less likely to improve than others). Owing to their measurement properties and the availability of data from their current widespread use in the NHS, the Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were selected as the most appropriate scores to use in developing the Arthroplasty Candidacy Help Engine (ACHE) tool. The change in score and the probability of an improvement were then calculated and modelled using preoperative and postoperative OKS/OHSs and PROM scores, thereby creating the ACHE tool. Markov models were used to assess the cost-effectiveness of total hip/knee arthroplasty in the NHS for different preoperative values of OKS/OHSs over a 10-year period. The threshold values were used to model how the ACHE tool may change the number of referrals in a single UK musculoskeletal hub. A user group was established that included patients, members of the public and health-care representatives, to provide stakeholder feedback throughout the research process. RESULTS: From a shortlist of four scores, the OHS and OKS were selected for the ACHE tool based on their measurement properties, calculated preoperative thresholds and cost-effectiveness data. The absolute threshold was 40 for the OHS and 41 for the OKS using the preferred improvement criterion. A range of relative thresholds were calculated based on the relationship between a patient's preoperative score and their probability of improving after surgery. For example, a preoperative OHS of 35 or an OKS of 30 translates to a 75{\%} probability of achieving a good outcome from surgical intervention. The economic evaluation demonstrated that hip and knee arthroplasty cost of < £20,000 per quality-adjusted life-year for patients with any preoperative score below the absolute thresholds (40 for the OHS and 41 for the OKS). Arthroplasty was most cost-effective for patients with lower preoperative scores. LIMITATIONS: The ACHE tool supports but does not replace the shared decision-making process required before an individual decides whether or not to undergo surgery. CONCLUSION: The OHS and OKS can be used in the ACHE tool to assess an individual patient's suitability for hip/knee replacement surgery. The system enables evidence-based and informed threshold setting in accordance with local resources and policies. At a population level, both hip and knee arthroplasty are highly cost-effective right up to the absolute threshold for intervention. Our stakeholder user group felt that the ACHE tool was a useful evidence-based clinical tool to aid referrals and that it should be trialled in NHS clinical practice to establish its feasibility. FUTURE WORK: Future work could include (1) a real-world study of the ACHE tool to determine its acceptability to patients and general practitioners and (2) a study of the role of the ACHE tool in supporting referral decisions. FUNDING: The National Institute for Health Research Health Technology Assessment programme.",
keywords = "Knee, Hip, Osteoarthritis, Arthroplasty, Referral, Outcome, Systematic review, Threshold, Cost-utility analysis",
author = "Andrew Price and James Smith and H Dakin and Sujin Kang and Peter Eibich and Jonathan Cook and Alastair Gray and Kristina Harris and Robert Middleton and Elizabeth Gibbons and Elena Benedetto and Stephanie Smith and Jill Dawson and Raymond Fitzpatrick and Adrian Sayers and Laura Miller and Elsa Marques and Rachael Gooberman-Hill and Ashley Blom and Andrew Judge and Arden, {Nigel K} and David Murray and Sion Glyn-Jones and Karen Barker and Andrew Carr and David Beard",
year = "2019",
month = "7",
day = "1",
doi = "10.3310/hta23320",
language = "English",
volume = "23",
pages = "1--216",
journal = "Health Technology Assessment",
issn = "1366-5278",
publisher = "NIHR Journals Library",
number = "32",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery

T2 - development and economic modelling

AU - Price, Andrew

AU - Smith, James

AU - Dakin , H

AU - Kang, Sujin

AU - Eibich, Peter

AU - Cook, Jonathan

AU - Gray, Alastair

AU - Harris, Kristina

AU - Middleton, Robert

AU - Gibbons, Elizabeth

AU - Benedetto, Elena

AU - Smith, Stephanie

AU - Dawson, Jill

AU - Fitzpatrick, Raymond

AU - Sayers, Adrian

AU - Miller, Laura

AU - Marques, Elsa

AU - Gooberman-Hill, Rachael

AU - Blom, Ashley

AU - Judge, Andrew

AU - Arden, Nigel K

AU - Murray, David

AU - Glyn-Jones, Sion

AU - Barker, Karen

AU - Carr, Andrew

AU - Beard, David

PY - 2019/7/1

Y1 - 2019/7/1

N2 - BACKGROUND: There is no good evidence to support the use of patient-reported outcome measures (PROMs) in setting preoperative thresholds for referral for hip and knee replacement surgery. Despite this, the practice is widespread in the NHS. OBJECTIVES/RESEARCH QUESTIONS: Can clinical outcome tools be used to set thresholds for hip or knee replacement? What is the relationship between the choice of threshold and the cost-effectiveness of surgery? METHODS: A systematic review identified PROMs used to assess patients undergoing hip/knee replacement. Their measurement properties were compared and supplemented by analysis of existing data sets. For each candidate score, we calculated the absolute threshold (a preoperative level above which there is no potential for improvement) and relative thresholds (preoperative levels above which individuals are less likely to improve than others). Owing to their measurement properties and the availability of data from their current widespread use in the NHS, the Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were selected as the most appropriate scores to use in developing the Arthroplasty Candidacy Help Engine (ACHE) tool. The change in score and the probability of an improvement were then calculated and modelled using preoperative and postoperative OKS/OHSs and PROM scores, thereby creating the ACHE tool. Markov models were used to assess the cost-effectiveness of total hip/knee arthroplasty in the NHS for different preoperative values of OKS/OHSs over a 10-year period. The threshold values were used to model how the ACHE tool may change the number of referrals in a single UK musculoskeletal hub. A user group was established that included patients, members of the public and health-care representatives, to provide stakeholder feedback throughout the research process. RESULTS: From a shortlist of four scores, the OHS and OKS were selected for the ACHE tool based on their measurement properties, calculated preoperative thresholds and cost-effectiveness data. The absolute threshold was 40 for the OHS and 41 for the OKS using the preferred improvement criterion. A range of relative thresholds were calculated based on the relationship between a patient's preoperative score and their probability of improving after surgery. For example, a preoperative OHS of 35 or an OKS of 30 translates to a 75% probability of achieving a good outcome from surgical intervention. The economic evaluation demonstrated that hip and knee arthroplasty cost of < £20,000 per quality-adjusted life-year for patients with any preoperative score below the absolute thresholds (40 for the OHS and 41 for the OKS). Arthroplasty was most cost-effective for patients with lower preoperative scores. LIMITATIONS: The ACHE tool supports but does not replace the shared decision-making process required before an individual decides whether or not to undergo surgery. CONCLUSION: The OHS and OKS can be used in the ACHE tool to assess an individual patient's suitability for hip/knee replacement surgery. The system enables evidence-based and informed threshold setting in accordance with local resources and policies. At a population level, both hip and knee arthroplasty are highly cost-effective right up to the absolute threshold for intervention. Our stakeholder user group felt that the ACHE tool was a useful evidence-based clinical tool to aid referrals and that it should be trialled in NHS clinical practice to establish its feasibility. FUTURE WORK: Future work could include (1) a real-world study of the ACHE tool to determine its acceptability to patients and general practitioners and (2) a study of the role of the ACHE tool in supporting referral decisions. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

AB - BACKGROUND: There is no good evidence to support the use of patient-reported outcome measures (PROMs) in setting preoperative thresholds for referral for hip and knee replacement surgery. Despite this, the practice is widespread in the NHS. OBJECTIVES/RESEARCH QUESTIONS: Can clinical outcome tools be used to set thresholds for hip or knee replacement? What is the relationship between the choice of threshold and the cost-effectiveness of surgery? METHODS: A systematic review identified PROMs used to assess patients undergoing hip/knee replacement. Their measurement properties were compared and supplemented by analysis of existing data sets. For each candidate score, we calculated the absolute threshold (a preoperative level above which there is no potential for improvement) and relative thresholds (preoperative levels above which individuals are less likely to improve than others). Owing to their measurement properties and the availability of data from their current widespread use in the NHS, the Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were selected as the most appropriate scores to use in developing the Arthroplasty Candidacy Help Engine (ACHE) tool. The change in score and the probability of an improvement were then calculated and modelled using preoperative and postoperative OKS/OHSs and PROM scores, thereby creating the ACHE tool. Markov models were used to assess the cost-effectiveness of total hip/knee arthroplasty in the NHS for different preoperative values of OKS/OHSs over a 10-year period. The threshold values were used to model how the ACHE tool may change the number of referrals in a single UK musculoskeletal hub. A user group was established that included patients, members of the public and health-care representatives, to provide stakeholder feedback throughout the research process. RESULTS: From a shortlist of four scores, the OHS and OKS were selected for the ACHE tool based on their measurement properties, calculated preoperative thresholds and cost-effectiveness data. The absolute threshold was 40 for the OHS and 41 for the OKS using the preferred improvement criterion. A range of relative thresholds were calculated based on the relationship between a patient's preoperative score and their probability of improving after surgery. For example, a preoperative OHS of 35 or an OKS of 30 translates to a 75% probability of achieving a good outcome from surgical intervention. The economic evaluation demonstrated that hip and knee arthroplasty cost of < £20,000 per quality-adjusted life-year for patients with any preoperative score below the absolute thresholds (40 for the OHS and 41 for the OKS). Arthroplasty was most cost-effective for patients with lower preoperative scores. LIMITATIONS: The ACHE tool supports but does not replace the shared decision-making process required before an individual decides whether or not to undergo surgery. CONCLUSION: The OHS and OKS can be used in the ACHE tool to assess an individual patient's suitability for hip/knee replacement surgery. The system enables evidence-based and informed threshold setting in accordance with local resources and policies. At a population level, both hip and knee arthroplasty are highly cost-effective right up to the absolute threshold for intervention. Our stakeholder user group felt that the ACHE tool was a useful evidence-based clinical tool to aid referrals and that it should be trialled in NHS clinical practice to establish its feasibility. FUTURE WORK: Future work could include (1) a real-world study of the ACHE tool to determine its acceptability to patients and general practitioners and (2) a study of the role of the ACHE tool in supporting referral decisions. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

KW - Knee

KW - Hip

KW - Osteoarthritis

KW - Arthroplasty

KW - Referral

KW - Outcome

KW - Systematic review

KW - Threshold

KW - Cost-utility analysis

UR - http://www.scopus.com/inward/record.url?scp=85069302502&partnerID=8YFLogxK

U2 - 10.3310/hta23320

DO - 10.3310/hta23320

M3 - Article

VL - 23

SP - 1

EP - 216

JO - Health Technology Assessment

JF - Health Technology Assessment

SN - 1366-5278

IS - 32

ER -