Effects of Arthroscopy for Femoroacetabular Impingement Syndrome on Quality of Life and Economic Outcomes

2018 ◽  
Vol 46 (5) ◽  
pp. 1205-1213 ◽  
Author(s):  
Richard C. Mather ◽  
Shane J. Nho ◽  
Andrew Federer ◽  
Berna Demiralp ◽  
Jennifer Nguyen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Indirect Cost ◽  
Functional Status ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Nonoperative Treatment ◽  
Economic Benefits ◽  
The Mean ◽  
Mean Cost ◽  
Fai Syndrome

Background: The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. Purpose: This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: The cost-effectiveness of hip arthroscopy versus nonoperative treatment was evaluated by calculating direct and indirect treatment costs. Direct cost was calculated with Current Procedural Terminology medical codes associated with FAI treatment. Indirect cost was measured with the patient-reported data of 102 patients who underwent arthroscopy and from the reimbursement records of 32,143 individuals between the ages of 16 and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. The indirect economic benefits of hip arthroscopy were inferred through regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. To analyze cost-effectiveness, 1-, 2-, and 3-way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis evaluated the impact of uncertainty in the model assumptions. Results: Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity of $8968 after surgery. Cost-effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy versus nonoperative treatment. Hip arthroscopy also conferred a gain of 2.03 quality-adjusted life years over this period. The mean cost for hip arthroscopy was estimated at $23,120 ± $10,279, and the mean cost of nonoperative treatment was estimated at $91,602 ± $14,675. In 99% of trials, hip arthroscopy was recognized as the preferred cost-effective strategy. Conclusion: FAI syndrome produces a substantial economic burden on society that may be reduced through the indirect cost savings and economic benefits from hip arthroscopy.

scholarly journals Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098753
Author(s):  
Cammille C. Go ◽  
Cynthia Kyin ◽  
Jeffrey W. Chen ◽  
Benjamin G. Domb ◽  
David R. Maldonado
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Nonoperative Treatment ◽  
Cochrane Library ◽  
System Perspective ◽  
Labral Tears ◽  
The Cost

Background: Hip arthroscopy has frequently been shown to produce successful outcomes as a treatment for femoroacetabular impingement (FAI) and labral tears. However, there is less literature on whether the favorable results of hip arthroscopy can justify the costs, especially when compared with a nonoperative treatment. Purpose: To systematically review the cost-effectiveness of hip arthroscopy for treating FAI and labral tears. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed/MEDLINE, Embase, and Cochrane Library databases, and the Tufts University Cost-Effectiveness Analysis Registry were searched to identify articles that reported the cost per quality-adjusted life-year (QALY) generated by hip arthroscopy. The key terms used were “hip arthroscopy,” “cost,” “utility,” and “economic evaluation.” The threshold for cost-effectiveness was set at $50,000/QALY. The Methodological Index for Non-Randomized Studies instrument and Quality of Health Economic Studies (QHES) score were used to determine the quality of the studies. This study was prospectively registered on PROSPERO (CRD42020172991). Results: Six studies that reported the cost-effectiveness of hip arthroscopy were identified, and 5 of these studies compared hip arthroscopy to a nonoperative comparator. These studies were found to have a mean QHES score of 85.2 and a mean cohort age that ranged from 33-37 years. From both a health care system perspective and a societal perspective, 4 studies reported that hip arthroscopy was more costly but resulted in far greater gains than did nonoperative treatment. The preferred treatment strategy was most sensitive to duration of benefit, preoperative osteoarthritis, cost of the arthroscopy, and the improvement in QALYs with hip arthroscopy. Conclusion: In the majority of the studies, hip arthroscopy had a higher initial cost but provided greater gain in QALYs than did a nonoperative treatment. In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection. However, there is further need for literature to analyze willingness-to-pay thresholds.

Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review

2021 ◽  
pp. 036354652110389
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Matthew G. Davey ◽  
Jordan W. Fried ◽  
Andrew J. Hughes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Operative Management ◽  
Return To Play ◽  
Return To Sports ◽  
Level Of Evidence ◽  
The Mean

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.

An Economic Evaluation of a Community-Based Organization Led HIV Self-Testing Program Among Men Who Have Sex With Men in China

2020 ◽  
Author(s):  
Shanzi Huang ◽  
Jason Ong ◽  
Wencan Dai ◽  
Xi He ◽  
Yi Zhou ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Variable Cost ◽  
Community Based ◽  
Self Testing ◽  
Hiv Test ◽  
Community Based Organization ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Abstract Introduction: HIV self-testing (HIVST) is effective in improving the uptake of HIV testing among key populations. Complementary data on the cost-effectiveness of HIVST is critical for planning and scaling up HIVST. This study aimed to evaluate the cost-effectiveness of a community-based organization (CBO)-led HIVST model implemented in China. Method: A cost-effectiveness analysis (CEA) was conducted by comparing a CBO-led HIVST model with a CBO-led facility-based HIV rapid diagnostics testing (HIV-RDT) model. The full economic cost, including fixed and variable cost, from a health provider perspective using a micro costing approach was estimated. We determined the cost-effectiveness of these two HIV testing models over a two year time horizon (i.e. duration of the programs), and reported costs using US dollars (2020). Results: From January 2017 to December 2018, a total of 4,633 men tested in the HIVST model, and 1,780 men tested in the HIV-RDT model. The total number of new diagnosis was 155 for HIVST and 126 for the HIV-RDT model; the HIV test positivity was 3.3% (95% confidence interval (CI): 2.8-3.9) for the HIVST model and 7.1% (95% CI: 5.9-8.4) for the HIV-RDT model. The mean cost per person tested was $14.57 for HIVST and $24.74 for HIV-RDT. However, the mean cost per diagnosed was higher for HIVST ($435.52) compared with $349.44 for HIV-RDT.Conclusion: Our study confirms that compared to facility-based HIV-RDT, a community-based organization led HIVST program could have a cheaper mean cost per MSM tested for HIV in China. Better targeting of high-risk individuals would further improve the cost-effectiveness of HIVST.

Cost of Illness from the Public Payers’ Perspective in Patients with Ankylosing Spondylitis in Rheumatological Care

2010 ◽  
Vol 37 (11) ◽  
pp. 2348-2355 ◽  
Author(s):  
BRITTA STRÖMBECK ◽  
MARTIN ENGLUND ◽  
ANN BREMANDER ◽  
LENNART T.H. JACOBSSON ◽  
LJUBA KEDZA ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
General Population ◽  
Indirect Cost ◽  
Prescription Drugs ◽  
Reference Group ◽  
Fold Increase ◽  
Personal Identification ◽  
Total Cost ◽  
The Mean ◽  
Mean Cost

Objective.To estimate the incremental costs to public payers for patients with ankylosing spondylitis (AS) of working age compared with reference subjects from the general population.Methods.We investigated total costs for 3 years (2005–2007) in 116 outpatients under 66 years of age with AS attending rheumatological care in Malmö, Sweden. Mean (SD) age was 46 (11) years and mean (SD) disease duration was 24 (11) years. Two subjects per AS patient matched for age, sex, and residential area were selected from the Population Register to serve as a reference group. We retrieved data concerning sick leave, prescription drugs, and healthcare consumption from Swedish health-cost registers by the unique personal identification numbers.Results.The mean total cost for the 3-year period 2005–2007 was US $37,095 (SD $30,091) for patients with AS, and $11,071 (SD $22,340) for the reference group. The mean indirect cost was $19,618 and $5905, respectively. Mean cost for healthcare was $8998 for the AS patients and $4187 for the reference subjects, and mean cost for drugs was $8479 and $979, respectively. The patients with AS treated with biological therapy constituted 80% of the total drug cost, but just 40% of the cost for disability pension.Conclusion.Patients with AS had 3-fold increase in costs compared to reference subjects from the general population, and the drug costs were almost 10 times as high. Production losses (indirect cost) represented more than half of total cost (53%).

scholarly journals Nonoperative Management of Femoroacetabular Impingement: Clinical Outcomes at 5-Years--A Prospective Study (143)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0028
Author(s):  
Andrew Zogby ◽  
James Bomar ◽  
Kristina Johnson ◽  
Kelly Randich ◽  
Vidyadhar Upasani ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Patient Reported Outcomes ◽  
Operative Management ◽  
Activity Level ◽  
Treatment Groups ◽  
Patient Reported ◽  
The Mean ◽  
Non Operative Management ◽  
Fai Syndrome

Objectives: Mid-term and long-term outcomes data on non-operative management of femoroacetabular impingement (FAI) syndrome remains sparse despite expanding research on the topic. Our purpose is to present 5-year outcomes data utilizing a non-operative protocol on a consecutive series of patients with FAI syndrome. Methods: Between 2013 and 2016, patients were prospectively recruited in a non-operative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection. Patients with recurrent symptoms were offered arthroscopic treatment. Patient-reported outcomes including the modified Harris Hip Score (mHHS) and Non-arthritic Hip Score (NAHS) were collected 1-, 2-, and 5-years after enrollment. We present the 5-year data. Statistical analysis was performed to determine outcomes based on FAI type and treatment. Results: 133 hips in 100 patients were enrolled. Sixty-seven hips in 50 patients were available for 5-year follow up. At enrollment, the mean mHHS and NAHS were 69.6±13.1 and 76.3±14.7 respectively. In total, 73% of the cohort was managed non-operatively. Of the 11 patients requiring surgery, six (55%) converted to surgery within one year of enrollment, 4 (36%) converted to surgery between one and 2 years, and one patient converted to surgery between 2 and 5 years. At final follow up, the mean mHHS and NAHS were 89.6±10.7 and 88.0±12.1 respectively. At 1-year follow up, only the activity modification group made a significant increase in mHHS and NAHS (p<0.03), by two year follow up, all three treatment groups had made statistically significant improvements in mHHS and NAHS (p<0.05), by 5-years follow up, the activity modification group and the scope group had maintained their statistically significant improvement in mHHS and NAHS (p<0.03). There was no significant difference in mHHS or NAHS between treatment groups at 5-year follow-up (p>0.4)(Table 1), and no difference in proportion of hips meeting the MCID for mHHS based on treatment course (p=0.961). There was no difference in mHHS or NAHS between FAI types at any time point (p>0.06)(Table 2), or in the proportion of hips that met MCID among FAI types (p=0.511). 72% of patients returned to the same or similar sport/activity level, and there was no difference in the proportion of patients that returned to sports/activities among treatment type (p=0.095) or FAI type (p=0.273). Conclusions: Non-operative management of FAI syndrome is effective in a majority of adolescent patients, with robust improvements in patient-reported-outcomes persisting at 5-year follow-up.

scholarly journals Femoroacetabular impingement surgery allows 74% of athletes to return to the same competitive level of sports participation but their level of performance remains unreported: a systematic review with meta-analysis

2018 ◽  
Vol 52 (15) ◽  
pp. 972-981 ◽  
Author(s):  
Michael P Reiman ◽  
Scott Peters ◽  
Jonathan Sylvain ◽  
Seth Hagymasi ◽  
Richard C Mather ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Athletic Performance ◽  
Sport Participation ◽  
Return To Sport ◽  
Sports Participation ◽  
Computer Assisted ◽  
Post Surgery ◽  
Previous Level ◽  
The Mean ◽  
Fai Syndrome

BackgroundFemoroacetabular impingement (FAI) syndrome is one source of hip pain that can limit sport participation among athletes.ObjectiveTo summarise the return to sport (RTS) rate for athletes after surgery for FAI syndrome.MethodsA computer-assisted search of MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and EMBASE databases was performed using keywords related to RTS and RTS at preinjury level (RTSPRE) of competition for FAI syndrome. The risk of bias in the included studies was assessed using the Methodological Index for Non-Randomized Studies scale.Results35 studies (1634 athletes/1828 hips) qualified for analysis. Based on evidence of limited to moderate strength (level 3b to 4 studies), athletes return to sport at preinjury level post surgery for FAI syndrome at a rate of only 74% (67%–81%). Only 37% of studies reported RTSPRE. The mean time from surgery to RTS was 7.0±2.6 months. The mean follow-up postsurgery was 28.1±15.5 months. Professional athletes returned to sport (p=0.0002) (although not the preinjury sport level; p=0.63) at a higher rate than collegiate athletes. Only 14% of studies reported on athletic presurgery and postsurgery athletic performance, which means it is impossible to comment on whether athletes return to their previous level of performance or not. No studies reported on the specific criteria used to permit players to return to sport. 20% of studies reported on career longevity, 51% reported surgical complications and 77% reported on surgical failures.ConclusionThere was limited to moderate evidence that one in four athletes did not return to their previous level of sport participation after surgery for FAI syndrome. Only 37% of the included studies clearly distinguished RTS from RTSPRE. Poor outcome reporting on athletic performance postsurgery makes it difficult to determine to what level of performance these athletes actually perform. Thus, if a player asks a surgeon ‘Will I get back to my previous level of performance?’ there are presently little to no published data from which to base an answer.PROSPERO registration numberCRD42017072762.

scholarly journals Does capsular closure influence patient-reported outcomes in hip arthroscopy for femoroacetabular impingement and labral tear?

2019 ◽  
Vol 6 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Ran Atzmon ◽  
Zachary T Sharfman ◽  
Barak Haviv ◽  
Michal Frankl ◽  
Gilad Rotem ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Demographic Data ◽  
Labral Tear ◽  
Harris Hip Score ◽  
Patient Reported ◽  
Outcome Scores ◽  
The Mean

Abstract Capsulotomy is necessary to facilitate instrument manoeuvrability within the joint capsule in many arthroscopic hip surgical procedures. In cases where a clear indication for capsular closure does not exist, surgeon’s preference and experience often determines capsular management. The purpose of this study was to assess the influence of capsular closure on clinical outcome scores and satisfaction in patients who underwent hip arthroscopy surgery for femoroacetabular impingement (FAI) and labral tear. Data were prospectively collected and retrospectively analysed for hip arthroscopy surgeries with a minimum 2 years follow-up. Patients with developmental dysplasia of the hip, previous back or hip surgeries, and degenerative changes to this hip and secondary gains were excluded. Demographic data, intraoperative findings and patient-reported outcome scores were recorded, including the Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). A total of 29 and 35 patients were included in the non-closure and closure groups, respectively. The mean follow-up time was over 3 years for both groups. The mean pre-operative and post-operative HOS scores and MHHS scores did not significantly differ between groups (pre-operative HOS: 65.6 and 66.3, P = 0.898; post-operative HOS: 85.4 and 87.2, P = 0.718; pre-operative MHHS: 63.2 and 58.4, P = 0.223; post-operative MHHS: 85.7 and 88.7, P = 0.510). Overall patient satisfaction did not differ significantly between groups (non-closure 86.3%, closure group 88.6%; P = 0.672). Capsular closure did not significantly influence satisfaction or clinical outcome scores in patients who underwent arthroscopic hip surgery for FAI or labral tear.

Femoroacetabular Impingement in Professional Basketball Players: Return to Play, Career Length, and Performance After Hip Arthroscopy

2018 ◽  
Vol 46 (13) ◽  
pp. 3090-3096 ◽  
Author(s):  
J.P. Begly ◽  
Patrick S. Buckley ◽  
Hajime Utsunomiya ◽  
Karen K. Briggs ◽  
Marc J. Philippon
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Series ◽  
High Rate ◽  
Return To Play ◽  
Basketball Players ◽  
Level Of Evidence ◽  
Professional Basketball ◽  
Postoperative Performance ◽  
The Mean

Background: Previous studies have demonstrated that hip arthroscopy is an effective treatment for symptomatic femoroacetabular impingement (FAI) in professional athletes across a variety of sports. However, the return-to-play rates and postoperative performance of elite basketball players after hip arthroscopy are currently unknown. Purpose: To determine return-to-play rates and postoperative performance among professional basketball athletes after hip arthroscopy. Study Design: Case series; Level of evidence, 3. Methods: Eighteen professional basketball players underwent hip arthroscopy (24 hips) for symptomatic FAI between 2001 and 2016 by a single surgeon. Return to play was defined as competing in a single professional game of equal level after surgery. Data were retrospectively obtained for each player from basketball-reference.com , ESPN.com , eurobasket.com, and individual team websites. Matched controls were selected from the websites to compare performances. Results: The mean age at the time of surgery was 25.6 years, and the mean body mass index was 24.4 kg/m2. All players returned to their previous levels of competition, with a mean number of 4 seasons played after surgery (median, 3; range, 1-12). The mean ± SD time between the date of surgery and return to a professional game was 7.1 ± 4.4 months. There was no change in player efficiency rating when pre- and postinjury performance were compared. When compared with controls, players undergoing surgery also had no significant decline in player efficiency rating. Conclusion: Elite basketball athletes who undergo hip arthroscopy for the treatment of FAI return to their presurgical levels of competition at a high rate. These athletes demonstrate no significant overall decrease in performance upon their return to play.

scholarly journals The Key Parts of Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Implications for the Learning Curve

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110187
Author(s):  
Austin E. Wininger ◽  
Sherif Dabash ◽  
Thomas J. Ellis ◽  
Shane J. Nho ◽  
Joshua D. Harris
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Expert Opinion ◽  
Femoroacetabular Impingement ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Delphi Technique ◽  
High Volume ◽  
Reduce Risk ◽  
Fai Syndrome

Background: Hip arthroscopy is a rapidly growing surgical approach to treat femoroacetabular impingement (FAI) syndrome with a significant learning curve pertaining to complication risk, reoperation rate, and total hip arthroplasty conversion. Hip arthroscopy is more frequently being taught in residency and fellowship training. The key, or critical, parts of the technique have not yet been defined. Purpose: To identify the key components required to perform arthroscopic treatment of FAI syndrome. Study Design: Consensus statement. Methods: A 3-question survey comprising questions on hip arthroscopy for FAI was sent to a convenience sample of 101 high-volume arthroscopic hip surgeons in the United States. Surgeon career length (years) and maintenance volume (cases per year) were queried. Hip arthroscopy was divided into 10 steps using a Delphi technique to achieve a convergence of expert opinion. A step was considered “key” if it could (1) avoid complications, (2) reduce risk of revision arthroscopy, (3) reduce risk of total hip arthroplasty conversion, or (4) optimize patient-reported outcomes. Based on previous literature, steps with >90% of participants were defined as key. Descriptive and correlation statistics were calculated. Results: A total of 64 surgeons (63% response rate) reported 5.6 ± 2.1 steps as key (median, 6; range, 1-9). Most surgeons (56.3%) had been performing hip arthroscopy for >5 years. Most surgeons (71.9%) had performed >100 hip arthroscopy procedures per year. Labral treatment (97% agreement) and cam correction (91% agreement) were the 2 key steps of hip arthroscopy for FAI. Pincer/subspine correction (86% agreement), dynamic examination before capsular closure (63% agreement), and capsular management/closure (63% agreement) were selected by a majority of respondents but did not meet the study definition of key. There was no significant correlation between surgeon experience and designation of certain steps as key. Conclusion: Based on a Delphi technique and expert opinion survey of high-volume surgeons, labral treatment and cam correction are the 2 key parts of hip arthroscopy for FAI syndrome.

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