Diagrammatic representation of the Markov Model

States of the model in the represented by the ovals, transitions between states represented by the arrows

cPrimary

Primary THR

omrPTHR
1- (omrPTHR)

cSuccess

mr[age]
Successful Death
Primary
uSuccessP
omrRTHR + mr[age]
RR[age,sex,time]
mr[age]
cRevision cSuccess

Revision THR 1- (omrRTHR + mr[age]) Successful

Revision
uRevision uSuccessR
RRR

All transisition probability variables shown in blue

State cost variables shown in red
State utility variables shown in green
See <Parameters> page for definitions
Cost-effectiveness of Total Hip Replacement

Step 1: Choose male or female Step 2: Enter age of patient

Male
60 Patient age
Female (enter value between 40 and 90 years)

Results

Prosthesis Cost QALYs

Standard £ 512 14.65

NP1 £ 610 14.70
difference £ 98 0.04

ICERs:
NP1vStd £ 2,198 per QALY
Parameters

Name Value Description

age 60 Average age of all patients at receipt of primary implant

male 0 Sex indicator (0 for female, 1 for male)

cDR 6.0% Cost discount rate

oDR 1.5% Outcome discount rate

Transition probability variables (see diagram on page <Model Figure> for details)

omrPTHR 0.02 Operative mortality rate following primary THR

omrRTHR 0.02 Operative mortality rate following revision THR
rrr 0.04 Re-revision risk (assumed to be constant)

Revision rates for prostheses (see <Hazard function> for details)

cons -5.49 Constant in survival analysis for baseline hazard

ageC -0.04 Age coefficient in survival analysis for baseline hazard
maleC 0.77 Male coefficient in survival analysis for baseline hazard
lambda 0.00 Lambda parameter survival analysis (depends on chosen mix of above coefficients)
gamma 1.45 Ancilliary parameter in Weibull distribution
rrNP1 0.26 Relative risk of revision for new prosthesis 1 compared to standard

Resource cost parameters

cPrimary - Cost of a primary THR procedure

cRevision £ 5,294 Cost of one cycle in the Revision THR state (national reference costs for revision hip or knee)
cSuccess - Cost of one cycle in a 'success' state (primary or revision)
cStandard £ 394 Cost of standard prosthesis
cNP1 £ 579 Cost of new prosthesis 1

Utility of Markov states per cycle

uSuccessP 0.85 Utility score for having had a successful Primary THR
uSuccessR 0.75 Utility score for having a successful Revision THR
uRevision 0.30 Utility score during the revision period
Death Rates (per 1000 population per year) by age and sex

Age Males Females

35-44 1.51 0.99
45-54 3.93 2.6
55-64 10.9 6.7
65-74 31.6 19.3
75-84 80.1 53.5
85 and over 187.9 154.8

Yearly transition probabilities by age and sex

Age Index Males Females

35-44 35 0.00151 0.00099
45-54 45 0.00393 0.0026
55-64 55 0.0109 0.0067
65-74 65 0.0316 0.0193
75-84 75 0.0801 0.0535
85 and over 85 0.1879 0.1548
Modelling the hazard function for prosthesis failure

explanatory variables coefficient se hazard ratio

lngamma 0.37 0.05 1.454

cons -5.49 0.21 0.004
age -0.04 0.01 0.964
male 0.77 0.11 2.157
NP1 -1.34 0.38 0.261
 Standard

Model for standard prosthesis

Standard
Cycle Revision risk Death risk PrimaryTHR SuccessP RevisionTHR

0 1,000
1 0.05% 0.67% 980 -
2 0.08% 0.67% 973 1
3 0.10% 0.67% 965 1
4 0.12% 0.67% 958 1
5 0.13% 1.93% 938 1
6 0.14% 1.93% 918 1
7 0.15% 1.93% 899 2
8 0.17% 1.93% 880 2
9 0.17% 1.93% 862 2
10 0.18% 1.93% 844 2
11 0.19% 1.93% 826 2
12 0.20% 1.93% 808 2
13 0.21% 1.93% 791 2
14 0.22% 1.93% 774 2
15 0.22% 5.35% 731 2
16 0.23% 5.35% 690 2
17 0.24% 5.35% 651 2
18 0.24% 5.35% 615 2
19 0.25% 5.35% 581 2
20 0.25% 5.35% 548 2
21 0.26% 5.35% 517 2
22 0.27% 5.35% 488 2
23 0.27% 5.35% 461 2
24 0.28% 5.35% 435 2
25 0.28% 15.48% 366 2
26 0.29% 15.48% 309 2
27 0.29% 15.48% 260 2
28 0.30% 15.48% 219 1
29 0.30% 15.48% 184 1
30 0.31% 15.48% 155 1
31 0.31% 15.48% 131 1
32 0.32% 15.48% 110 1
33 0.32% 15.48% 93 1
34 0.33% 15.48% 78 1
35 0.33% 15.48% 66 0
36 0.33% 15.48% 55 0
37 0.34% 15.48% 47 0
38 0.34% 15.48% 39 0
39 0.35% 15.48% 33 0
40 0.35% 15.48% 28 0
41 0.35% 15.48% 23 0
42 0.36% 15.48% 20 0
43 0.36% 15.48% 17 0
44 0.37% 15.48% 14 0

Page 6
 Standard

45 0.37% 15.48% 12 0
46 0.37% 15.48% 10 0
47 0.38% 15.48% 8 0
48 0.38% 15.48% 7 0
49 0.38% 15.48% 6 0
50 0.39% 15.48% 5 0
51 0.39% 15.48% 4 0
52 0.40% 15.48% 3 0
53 0.40% 15.48% 3 0
54 0.40% 15.48% 2 0
55 0.41% 15.48% 2 0
56 0.41% 15.48% 2 0
57 0.41% 15.48% 1 0
58 0.42% 15.48% 1 0
59 0.42% 15.48% 1 0
60 0.42% 15.48% 1 0

Page 7
 Standard

Standard Prosthesis
SuccessR Death Check Cost Life-years QALYs

1,000 £ 394,000
- 20 1,000 £ - 980 821
- 27 1,000 £ 3,660 973 803
1 33 1,000 £ 4,333 967 785
2 40 1,000 £ 4,856 960 768
3 58 1,000 £ 5,226 942 742
4 76 1,000 £ 5,423 924 717
5 94 1,000 £ 5,540 906 692
6 112 1,000 £ 5,593 888 669
7 129 1,000 £ 5,598 871 646
9 146 1,000 £ 5,564 854 624
10 162 1,000 £ 5,499 838 603
11 178 1,000 £ 5,409 822 582
13 194 1,000 £ 5,299 806 562
14 210 1,000 £ 5,174 790 543
15 252 1,000 £ 5,037 748 506
15 292 1,000 £ 4,718 708 472
16 330 1,000 £ 4,415 670 440
17 366 1,000 £ 4,122 634 410
17 400 1,000 £ 3,841 600 382
18 432 1,000 £ 3,573 568 356
18 463 1,000 £ 3,318 537 332
18 491 1,000 £ 3,077 509 309
18 519 1,000 £ 2,850 481 288
19 544 1,000 £ 2,636 456 269
17 615 1,000 £ 2,435 385 224
15 675 1,000 £ 2,003 325 186
14 725 1,000 £ 1,653 275 155
12 768 1,000 £ 1,362 232 129
11 804 1,000 £ 1,122 196 107
10 834 1,000 £ 923 166 89
9 860 1,000 £ 758 140 74
8 881 1,000 £ 623 119 62
7 900 1,000 £ 511 100 51
6 915 1,000 £ 419 85 43
5 928 1,000 £ 343 72 36
5 940 1,000 £ 281 60 30
4 949 1,000 £ 230 51 25
4 957 1,000 £ 188 43 21
3 964 1,000 £ 154 36 17
3 969 1,000 £ 125 31 14
2 974 1,000 £ 102 26 12
2 978 1,000 £ 84 22 10
2 981 1,000 £ 68 19 8
2 984 1,000 £ 56 16 7

Page 8
 Standard

1 987 1,000 £ 45 13 6
1 989 1,000 £ 37 11 5
1 991 1,000 £ 30 9 4
1 992 1,000 £ 24 8 3
1 993 1,000 £ 20 7 3
1 994 1,000 £ 16 6 2
1 995 1,000 £ 13 5 2
1 996 1,000 £ 11 4 2
0 997 1,000 £ 9 3 1
0 997 1,000 £ 7 3 1
0 998 1,000 £ 6 2 1
0 998 1,000 £ 5 2 1
0 998 1,000 £ 4 2 1
0 999 1,000 £ 3 1 1
0 999 1,000 £ 2 1 0
0 999 1,000 £ 2 1 0
STDcost STDlys STDqalys
£ 512 20.91 14.65

Page 9
 NP1

Model for first new prosthesis

First New
Cycle Revision risk Death risk PrimaryTHR SuccessP RevisionTHR

0 1,000
1 0.01% 0.67% 980 -
2 0.02% 0.67% 973 0
3 0.03% 0.67% 966 0
4 0.03% 0.67% 960 0
5 0.03% 1.93% 941 0
6 0.04% 1.93% 922 0
7 0.04% 1.93% 904 0
8 0.04% 1.93% 886 0
9 0.05% 1.93% 869 0
10 0.05% 1.93% 852 0
11 0.05% 1.93% 835 1
12 0.05% 1.93% 818 1
13 0.05% 1.93% 802 1
14 0.06% 1.93% 786 1
15 0.06% 5.35% 744 1
16 0.06% 5.35% 703 1
17 0.06% 5.35% 665 1
18 0.06% 5.35% 629 1
19 0.06% 5.35% 595 1
20 0.07% 5.35% 563 1
21 0.07% 5.35% 532 1
22 0.07% 5.35% 504 1
23 0.07% 5.35% 476 1
24 0.07% 5.35% 450 1
25 0.07% 15.48% 380 1
26 0.08% 15.48% 321 0
27 0.08% 15.48% 271 0
28 0.08% 15.48% 229 0
29 0.08% 15.48% 193 0
30 0.08% 15.48% 163 0
31 0.08% 15.48% 138 0
32 0.08% 15.48% 116 0
33 0.08% 15.48% 98 0
34 0.08% 15.48% 83 0
35 0.09% 15.48% 70 0
36 0.09% 15.48% 59 0
37 0.09% 15.48% 50 0
38 0.09% 15.48% 42 0
39 0.09% 15.48% 36 0
40 0.09% 15.48% 30 0
41 0.09% 15.48% 25 0
42 0.09% 15.48% 21 0
43 0.09% 15.48% 18 0
44 0.10% 15.48% 15 0

Page 10
 NP1

45 0.10% 15.48% 13 0
46 0.10% 15.48% 11 0
47 0.10% 15.48% 9 0
48 0.10% 15.48% 8 0
49 0.10% 15.48% 7 0
50 0.10% 15.48% 6 0
51 0.10% 15.48% 5 0
52 0.10% 15.48% 4 0
53 0.10% 15.48% 3 0
54 0.11% 15.48% 3 0
55 0.11% 15.48% 2 0
56 0.11% 15.48% 2 0
57 0.11% 15.48% 2 0
58 0.11% 15.48% 1 0
59 0.11% 15.48% 1 0
60 0.11% 15.48% 1 0

Page 11
 NP1

First New Prosthesis

SuccessR Death Check Cost Life-years QALYs

1,000 £ 579,000
- 20 1,000 £ - 980 821
- 27 1,000 £ 954 973 803
0 33 1,000 £ 1,131 967 786
0 40 1,000 £ 1,268 960 769
1 58 1,000 £ 1,366 942 743
1 76 1,000 £ 1,419 924 718
1 94 1,000 £ 1,451 906 693
2 112 1,000 £ 1,466 888 670
2 129 1,000 £ 1,469 871 647
2 146 1,000 £ 1,462 854 625
3 162 1,000 £ 1,446 838 604
3 178 1,000 £ 1,424 822 584
3 194 1,000 £ 1,397 806 564
4 210 1,000 £ 1,366 790 545
4 252 1,000 £ 1,332 748 508
4 292 1,000 £ 1,249 708 474
4 330 1,000 £ 1,170 670 442
4 366 1,000 £ 1,094 634 412
5 400 1,000 £ 1,021 600 384
5 432 1,000 £ 951 568 358
5 462 1,000 £ 885 538 334
5 491 1,000 £ 822 509 311
5 518 1,000 £ 762 482 290
5 544 1,000 £ 706 456 271
4 615 1,000 £ 653 385 225
4 674 1,000 £ 538 326 188
4 725 1,000 £ 445 275 156
3 767 1,000 £ 367 233 130
3 803 1,000 £ 303 197 108
3 834 1,000 £ 250 166 90
2 860 1,000 £ 206 140 75
2 881 1,000 £ 169 119 62
2 900 1,000 £ 139 100 52
2 915 1,000 £ 114 85 43
1 928 1,000 £ 94 72 36
1 939 1,000 £ 77 61 30
1 949 1,000 £ 63 51 25
1 957 1,000 £ 52 43 21
1 963 1,000 £ 42 37 17
1 969 1,000 £ 35 31 14
1 974 1,000 £ 28 26 12
1 978 1,000 £ 23 22 10
1 981 1,000 £ 19 19 8
0 984 1,000 £ 15 16 7

Page 12
 NP1

0 987 1,000 £ 13 13 6
0 989 1,000 £ 10 11 5
0 990 1,000 £ 8 10 4
0 992 1,000 £ 7 8 3
0 993 1,000 £ 6 7 3
0 994 1,000 £ 5 6 2
0 995 1,000 £ 4 5 2
0 996 1,000 £ 3 4 2
0 997 1,000 £ 2 3 1
0 997 1,000 £ 2 3 1
0 998 1,000 £ 2 2 1
0 998 1,000 £ 1 2 1
0 998 1,000 £ 1 2 1
0 999 1,000 £ 1 1 1
0 999 1,000 £ 1 1 0
0 999 1,000 £ 1 1 0
NP1cost NP1lys NP1qalys
£ 610 20.92 14.70

Page 13