LOCAL ANAESTHETIC WOUND INFILTRATION IN ADDITION TO STANDARD ANAESTHESIA IN TOTAL HIP AND KNEE ARTHROPLASTY: LONG-TERM COST-EFFECTIVENESS ALONGSIDE THE APEX TRIALS IN BRISTOL, UK

E. M. Marques; A. W. Blom; L. Erik; W. Vikki; N. Sian

doi:10.1302/1358-992X.2018.3.012

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LOCAL ANAESTHETIC WOUND INFILTRATION IN ADDITION TO STANDARD ANAESTHESIA IN TOTAL HIP AND KNEE ARTHROPLASTY: LONG-TERM COST-EFFECTIVENESS ALONGSIDE THE APEX TRIALS IN BRISTOL, UK

The European Orthopaedic Research Society (EORS) 25th Annual and Anniversary Meeting, Munich, Germany, September 2017. Part 1 of 2.

E. M. Marques
A. W. Blom
L. Erik
W. Vikki
N. Sian

LOCAL ANAESTHETIC WOUND INFILTRATION IN ADDITION TO STANDARD ANAESTHESIA IN TOTAL HIP AND KNEE ARTHROPLASTY: LONG-TERM COST-EFFECTIVENESS ALONGSIDE THE APEX TRIALS IN BRISTOL, UK

Marques EM, Blom AW, Erik L, Vikki W, Sian N. LOCAL ANAESTHETIC WOUND INFILTRATION IN ADDITION TO STANDARD ANAESTHESIA IN TOTAL HIP AND KNEE ARTHROPLASTY: LONG-TERM COST-EFFECTIVENESS ALONGSIDE THE APEX TRIALS IN BRISTOL, UK. Orthop Procs. 2018;100-B(SUPP_3):12-12. doi:10.1302/1358-992X.2018.3.012

Marques, E. M., et al. “LOCAL ANAESTHETIC WOUND INFILTRATION IN ADDITION TO STANDARD ANAESTHESIA IN TOTAL HIP AND KNEE ARTHROPLASTY: LONG-TERM COST-EFFECTIVENESS ALONGSIDE THE APEX TRIALS IN BRISTOL, UK.” Orthopaedic Proceedings, vol. 100-B, no. SUPP_3, 2018, pp. 12-12., https://doi.org/10.1302/1358-992X.2018.3.012

Marques, E. M., Blom, A. W., Erik, L., Vikki, W., & Sian, N. (2018). LOCAL ANAESTHETIC WOUND INFILTRATION IN ADDITION TO STANDARD ANAESTHESIA IN TOTAL HIP AND KNEE ARTHROPLASTY: LONG-TERM COST-EFFECTIVENESS ALONGSIDE THE APEX TRIALS IN BRISTOL, UK. Orthopaedic Proceedings, 100-B(SUPP_3), 12-12. https://doi.org/10.1302/1358-992X.2018.3.012

Marques, E. M., Blom, A. W., Erik, L., Vikki, W. and Sian, N. (2018) “LOCAL ANAESTHETIC WOUND INFILTRATION IN ADDITION TO STANDARD ANAESTHESIA IN TOTAL HIP AND KNEE ARTHROPLASTY: LONG-TERM COST-EFFECTIVENESS ALONGSIDE THE APEX TRIALS IN BRISTOL, UK.” Orthopaedic Proceedings, 100-B(SUPP_3), pp. 12-12. Available at: https://doi.org/10.1302/1358-992X.2018.3.012

Marques, E. M., A. W. Blom, L. Erik, W. Vikki, and N. Sian. “LOCAL ANAESTHETIC WOUND INFILTRATION IN ADDITION TO STANDARD ANAESTHESIA IN TOTAL HIP AND KNEE ARTHROPLASTY: LONG-TERM COST-EFFECTIVENESS ALONGSIDE THE APEX TRIALS IN BRISTOL, UK.” Orthopaedic Proceedings 100-B, no. SUPP_3 (2018): 12-12. https://doi.org/10.1302/1358-992X.2018.3.012

Marques EM, Blom AW, Erik L, Vikki W, Sian N. LOCAL ANAESTHETIC WOUND INFILTRATION IN ADDITION TO STANDARD ANAESTHESIA IN TOTAL HIP AND KNEE ARTHROPLASTY: LONG-TERM COST-EFFECTIVENESS ALONGSIDE THE APEX TRIALS IN BRISTOL, UK. Orthop Procs. 2018 Apr 1;100-B(SUPP_3):12-12. https://doi.org/10.1302/1358-992X.2018.3.012

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Abstract

Background

The Arthroplasty Pain Experience (APEX) studies are two randomised controlled trials in primary total hip (THR) and knee replacement (TKR) at a large UK orthopaedics centre. APEX investigated the effect of local anaesthetic wound infiltration (LAI), administered before wound closure, in addition to standard analgesia, on pain severity at 12 months. This abstract reports results of the within-trial economic evaluations.

Methods

Cost-effectiveness was assessed from the health and social care payer perspective in relation to quality adjusted life years (QALYs). Resource use was collected from hospital records and patient-completed postal questionnaires, and valued using unit cost estimates from local NHS Trust and national tariffs. Missing data were imputed using chained equations. Costs and outcomes were compared per trial arm and plotted in cost-effectiveness planes. The economic results were bootstrapped incremental net monetary benefit statistics (INMB) and cost-effectiveness acceptability curves. One-way deterministic sensitivity analyses explored any methodological uncertainty.

Results

In both trials, LAI was cost-saving and more effective than standard care. Using the £20,000 per QALY threshold, in THR, the INMB was £1,125 (95%BCI, £183 to £2,067) and the probability of being cost-effective was over 98%. In TKR, the INMB was £264 (95%BCI, −£710 to £1,238), with only 62% probability of being cost-effective. Considering an NHS perspective only, LAI was no longer dominant in THR, but still highly cost-effective, with an INMB of £961 (95%BCI, £50 to £1,873).

Conclusions

Administering LAI is a cost-effective treatment option in THR and TKR surgeries. The evidence is stronger for THR, because of larger QALY gain. In TKR, there is more uncertainty around the economic result, and smaller QALY gains, but results point to LAI being cheaper than standard analgesia, which includes a femoral nerve block.