Evaluating the clinical and cost effectiveness of total joint replacement
- Research Opportunity
- Project Status
- St Vincent's Hospital
|A/Prof Michelle Dowsey||Personal web page|
|Prof Philip Clarke||Personal web page|
Annually more than 100,000 joints are replaced in Australia, making it one of the most common elective surgical procedures in this country. Joint replacement numbers are expected to double within the next 30 years and while considered a highly successful procedure, controversies exist regarding best practice in several key areas of surgical practice. These controversies include; patella resurfacing and the use of computer navigation in total knee replacement, surgical approach and cementation techniques in total hip replacement. Despite numerous randomised controlled trials interrogating these issues, there remains little definitive evidence to preference one practice over another and as a consequence, decisions are largely based on surgeon preference. Although joint replacement has proven to be cost-effective treatments for end-stage osteoarthritis, studies have also shown that the cost of surgery can vary between patient subgroups. Measuring value and understanding the cost of services is imperative in healthcare where providers are challenged to balance between the provision of quality care and cost containment.
This study will use a unique dedicated clinical registry that includes high quality patient reported outcome measures for a group of nationally representative joint replacement patients, to interrogate the cost implications of common surgical practices. The St. Vincent’s Melbourne Arthroplasty Outcomes Registry (SMART) is a registry which collects both clinical and patient reported outcomes in patients who have undergone elective lower limb joint replacement at St. Vincent’s Hospital. The registry has recorded information on patient demographics, surgery details and death for these patients since 1998. From 2006, the collection of patient reported HRQL was initiated and patients are followed-up at regular time intervals. Using techniques such as instrumental variable analysis, propensity score analysis and Markov modelling, the aim of this study will be to evaluate the clinical and cost effectiveness of common surgical practices and in doing so inform the evidence base for surgical decision making in total joint replacement Preferred prerequisite studies: orthopaedics/musculoskeletal disease, epidemiology, health economics
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