Cost-effectiveness of enhanced recovery in hip and knee replacement: a systematic review protocol

Author:

Murphy JacquelineORCID,Pritchard Mark G,Cheng Lok Yin,Janarthanan Roshni,Leal JoséORCID

Abstract

IntroductionHip and knee replacement represents a significant burden to the UK healthcare system. ‘Enhanced recovery’ pathways have been introduced in the National Health Service (NHS) for patients undergoing hip and knee replacement, with the aim of improving outcomes and timely recovery after surgery. To support policymaking, there is a need to evaluate the cost-effectiveness of enhanced recovery pathways across jurisdictions. Our aim is to systematically summarise the published cost-effectiveness evidence on enhanced recovery in hip and knee replacement, both as a whole and for each of the various components of enhanced recovery pathways.Methods and analysisA systematic review will be conducted using MEDLINE, EMBASE, Econlit and the National Health Service Economic Evaluations Database. Separate search strategies were developed for each database including terms relating to hip and knee replacement/arthroplasty, economic evaluations, decision modelling and quality of life measures.We will extract peer-reviewed studies published between 2000 and 2017 reporting economic evaluations of preoperative, perioperative or postoperative enhanced recovery interventions within hip or knee replacement. Economic evaluations alongside cohort studies or based on decision models will be included. Only studies with patients undergoing elective replacement surgery of the hip or knee will be included. Data will be extracted using a predefined pro forma following best practice guidelines for economic evaluation, decision modelling and model validation.Our primary outcome will be the cost-effectiveness of enhanced recovery (entire pathway and individual components) in terms of incremental cost per quality-adjusted life year. A narrative synthesis of all studies will be presented, focussing on cost-effectiveness results, study design, quality and validation status.Ethics and disseminationThis systematic review is exempted from ethics approval because the work is carried out on published documents. The results of the review will be disseminated in a peer-reviewed academic journal and at conferences.PROSPERO registration numberCRD42017059473.

Funder

Health Services and Delivery Research Programme

Publisher

BMJ

Subject

General Medicine

Reference26 articles.

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2. National Joint Registry. Secondary 13th annual report (online statistics): procedure details by type of provider (knee). 2016 http://www.njrreports.org.uk/knees-all-procedures-activity (accessed 12 Dec 2016).

3. Department of Health. Enhanced Recovery Partnership Project Report – March 2011 : Department of Health, NHS Improvement NCAT, NHS Institute, 2011.

4. Enhanced Recovery Partnership Programme. Delivering enhanced recovery – helping patients to get better sooner after surgery Department of Health, 2010.

5. Current Status of Cost Utility Analyses in Total Joint Arthroplasty: A Systematic Review

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