Authors' objectives:

"The aim of this technology assessment is to examine the impact of adopting MI THR into the Canadian health system by answering the following questions: 1) What are the known clinical effects of MI THR techniques compared to standard THR for patients undergoing primary THR? 2) What is the cost-effectiveness of MI THR techniques compared to standard THR? 3) What is the potential financial impact of increased adoption of MI THR techniques? The study was conducted in collaboration with the United Kingdom's National Institute for Health Research (NIHR) and includes a systematic review of the clinical evidence and a cost-utility analysis." (executive summary)

Authors' recommendations: Despite the number of studies identified, there was little evidence of any longer-term differences between MI THR and standard THR. This is mainly because of the lack of data available. In addition, surrogates for longer-term outcomes provided insufficient information with which to make judgements about longer-term performance. Overall, it seems likely that the MI approach offers some peri-operative advantages regarding blood loss and operative time, although these may be of limited clinical significance. The MI approach may also offer a shorter recovery period, as identified by the shorter length of hospital stay and time to return to usual activities. Two economic evaluations of MI THR were identified. Both were of poor quality and did not provide useful information. The economic analysis found little difference between therapies in costs and QALYs. Single-incision MI THR was more expensive with more QALYs. The incremental cost per QALY gained was CAD148,000. The results were sensitive to changes in parameters, and value of information analysis confirms the benefit from conducting more research. In conclusion, given the level of clinical evidence available and the results of the economic evaluation, greater value seems to be gained from conducting a larger definitive RCT focusing on long-term revision rates rather than providing funding for the expansion of MI THR.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://cadth.ca/index.php/en/hta/reports-publications/search/publication /794

Year Published: 2008

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)