Lifetime cost-effectiveness of alternative prosthesis brands for total hip replacement - A study using the NJR dataset

Sep 8, 2026

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Hip prosthesis brands show limited evidence regarding cost-effectiveness, particularly over patients’ lifetimes. Lifetime outcomes for frequently used brands were compared by prosthesis type—cemented, cementless, and hybrid—using linked English national databases to estimate revision risk, quality-adjusted life years (QALYs), and lifetime costs. For women with osteoarthritis aged 70, Exeter V40 Elite Plus Ogee showed the lowest revision risk and CPT Trilogy the highest QALYs. Under £20,000 per QALY, CPT Trilogy had the highest incremental net monetary benefit. Gains in quality of life after THR, rather than revision risk, drove cost-effectiveness; differences between several brands were small, warranting cautious interpretation.

LanguageEnglish

CategoryGeneral

FormatDOCX

Pages38

Reading Time13 min

AccessFree to download

Abstract

Introduction

Methods

Model overview

Sources of clinical data

Lifetime cost-effectiveness of alternative prosthesis brands for total hip replacement: A study using the NJR dataset Mark Pennington PhD lecturer in health economics, Richard Grieve PhD professor of health economics, Jan H. van der Meulen PhD professor of clinical epidemiology Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London, UK Address for correspondence Mark Pennington Email: HYPERLINK "mailto:mark.pennington@lshtm.ac.uk" mark.pennington@lshtm.ac.uk Tel +44 20 7927 2780 Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine 15-17 Tavistock Place London WC1H 9SH Author Contributions: Conception RG, JvM; analysis MP; manuscript drafting MP, RG, JvM; manuscript review MP, RG, JvM. ABSTRACT There is little evidence on the cost-effectiveness of hip prosthesis brands. We compared lifetime cost-effectiveness of frequently used brands within prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed), and hybrid prostheses (Exeter V40 Trilogy, Exeter V40 Trident, and CPT Trilogy). We used data from three linked English national databases to estimate lifetime revision risk, quality-adjusted life years (QALYs) and cost. For women with osteoarthritis aged 70, the Exeter V40 Elite Plus Ogee had the lowest revision risk (5.9% revision risk, 9.0 QALYs) and the CPT Trilogy had the highest QALYs (10.9% revision risk, 9.3 QALYs). Compared with the Corail Pinnacle (9.3% revision risk, 9.22 QALYs), the most commonly used brand, and assuming willingness-to-pay of £20,000 per QALY gain, the CPT Trilogy is most cost-effective with an incremental net monetary benefit of £876. Differences in cost-effectiveness between the hybrid CPT Trilogy and Exeter V40 Trident and the cementless Corail Pinnacle and Taperloc Exceed were small, and a cautious interpretation is required, given the limitations of the available information. However, it is unlikely that cemented brands are among the most cost-effective. Similar patterns of results were observed for men and other ages. The gain in quality of life after THR, rather than revision risk, was the main driver of cost-effectiveness. INTRODUCTION Total hip replacement (THR) is a highly effective surgical intervention improving quality of life (QoL) for patients with osteoarthritis.1 Many alternative prosthesis brands have been developed. There is considerable variation in the price of the different brands,2 but there is relatively little evidence on their effectiveness in terms of their durability and impact on patients’ symptoms, functional status and QoL.3,4 The currently available studies on the cost-effectiveness of prosthesis brands are outdated,5,6 which may account or the lack of recommendation of brands in the 2014 National Institute for Health and Care Excellence (NICE) guidance documents.7 Our previous economic evaluation comparing types of hip prostheses based on large national databases of patients who had a hip replacements in England or Wales found that fully cementless prostheses were less cost-effective than hybrid prostheses (with a cemented stem and cementless acetabular component) for most subgroups.8 Our comparison of outcomes of the THR with three frequently used brands within each type of reconstruction (cemented, uncemented, hybrid), based on the same national databases demonstrated that the largest improvements of symptoms and functional status (Oxford Hip Score, OHS) were seen with the hybrid cemented Exeter V40 stem and an uncemented Trident acetabular component (both Stryker, Newbury, United Kingdom) whereas 5-year revision rates were lowest with the fully cemented Exeter V40 stem and the Elite Plus Ogee acetabular component (DePuy, Leeds, United Kingdom).9 However, this study did not consider either revision rates beyond five years or costs. The aim of this pap

FAQs

What was the study’s main goal regarding hip prosthesis brands?

To compare lifetime cost-effectiveness of frequently used prosthesis brands for total hip replacement using linked national datasets.

Which outcomes were estimated to assess each brand?

Lifetime revision risk, quality-adjusted life years (QALYs), and lifetime costs for a hypothetical cohort.

What drove differences in cost-effectiveness across brands?

The gain in quality of life after THR, rather than revision risk.

Sep 8, 2026

Upload by Levi