Quality-adjusted life years gained in patients aged over 65 years after total hip replacement

Background: Total hip replacement (THR) is an effective, but cost-intensive health care procedure for older people. Because of demographic changes in Western Europe, THR-associated financial investment in health care has become a priority. To provide a quantitative rationale for a discussion within Western European health care systems, we undertook a prospective assessment of the benefit of an additional intervention following THR from the patientś perspective and as measured by quality-adjusted life years (QALYs). Aim: To measure the difference in health-related quality of life between an intervention (telephone support) and control group preoperatively and at follow-up 9. months after THR. Methods: A randomised clinical trial was conducted which allocated 180 patients aged over 65. years to either an intervention group or a control group. The control group received conventional treatment and the intervention group received both conventional treatment and telephone support after discharge. QALYs were calculated from measures of health-related quality of life using the SF-36 questionnaire. These scores were transformed to QALYs using a formula based on the method developed by Brazier et al. (1998). Results: Both the control and the intervention patients reported significant changes in health status from preoperative status at 3 and 9. months after surgery. Both groups group had a gain in QALYs. Interpretation: There was a significant gain in health status in both groups. However, no significant or clinically relevant differences between the two groups were observed at follow-up within this timeframe.