Representatives of Health Authorities and Payers seem to have mixed feelings about orthopaedic implants. They all know someone in their immediate environment who has had a new knee or a new hip and who is very satisfied with it. They also know that these people have regained their quality of life after a long period of pain and reduced mobility. Yet, when they look at their budgets, they get cold sweat.
There are indeed good reasons to be worried. A simple look at demographic predictions reveals that 21% of the EU population will be over 65 in just 5 years from now – a 4% jump from 2010. Predictions for 2060 are even more worrying, with 1 out of 3 citizens over 65. All over Europe, budgetary measures have been taken to try to make our generous social systems sustainable and orthopaedic implants have not been overlooked. Unfortunately for manufacturers, but most importantly for patients, implants do appear very prominently on the bill, making them an easy target when it comes to budget cuts. After all, it is much easier for any authority to ask for a discount than to implement complex in-house structural reforms.
In addition, in some countries, such as Germany, public opinion has been given the impression that use of implants is too high, only because the number of hip and knee implants is one of the highest in Europe. But before answering the question of overuse in Germany or underuse in other countries, one should answer the question of when the appropriate time for surgery in the care pathways is, and what is the economic impact of implementing this. We need solid scientific background to demonstrate that timely surgery is beneficial for both patients and health systems -in Germany and elsewhere-, and not a waste of resources. .
A new study on hip replacement in Germany1 from Dr. Ruben E Mujica-Mota, Ms Leala Watson and Prof Rosanna Tarricone proves what patients have known for decades. Having a “timely” hip replacement not only increases the number of healthy years, but it does so with no or very little incremental cost to the health system when compared with delaying the operation or not having a replacement at all. This study is not one of these single-company-or-product type of studies: it takes into account all the available scientific information so far through a systematic review of the literature, numerous publications, uses scientifically accepted models and is backed-up by world class Health Economics University Departments such as CERGAS of the Bocconi University and the University of Exeter Medical School.
Other than the cost factor, the study clearly proves that life is better for the patient after hip replacement.
In addition, several elements in the study clearly hint at the fact that timely surgery could also lead to a lower mortality rate, as restored mobility reduces the risks of cardiovascular diseases.
The abstract of the study is already available but once the full study is out, this should be mandatory reading for all the Health Payers and Institutional Health Buyers. Through its findings, the study can hopefully help payers to start looking at the outcomes and the full value of orthopaedic implants, and see this as an investment in health rather than a cost driver when offered at the right time.
Thank you researchers, it is now official: if you need a new hip, life will be better if you get one at the right time.
1. Cost-effectiveness of timely versus delayed primary total hip replacement in Germany by Dr. Ruben E Mujica-Mota, Ms. Leala Watson from the Institute of Health research, University of Exeter Medical School and Prof. Rosanna Tarricone from CERGAS, Bocconi University
