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 £ 394 0.00

NP1 £ 579 0.00
difference £ 185 0.00

ICERs:
NP1vStd #DIV/0! per QALY
Parameters Note that parameters coloured red are linked to the
probabilistic sensitivity analysis
2 0 Probabilistic? Note that parameters coloured green are endogenous
and so cannot be varied in the sensitivity analysis
Probabilistic Sensitivity Analysis only All other parameters are left deterministic
Name 'live' value Probabilistic deterministic standard error distribution alpha beta 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 1.00 Lambda parameter survival analysis (depends on chosen mix of above coefficients)
gamma 0.37 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 5294 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

Covariance matrix

lngamma cons age male NP1

lngamma 0.0023
cons -0.0057 0.0432
age 0.0000 -0.0008 0.0000
male 0.0000 -0.0072 0.0000 0.0119
NP1 0.0003 -0.0006 -0.0001 0.0002 0.1464

Cholesky decomposition

lngamma cons age male NP1

lngamma 0.0475
cons -0.1199 0.1698
age 0.0000 -0.0046 0.0024
male 0.0001 -0.0426 -0.0673 0.0745
NP1 0.0055 0.0001 -0.0456 -0.0386 0.3778

Random variables
z Tz mu + Tz
lngamma
cons
age
male
NP1
 Correlation matrix

NP2 lngamma cons age male NP1 NP2

lngamma 1
cons -0.577 1
age 0.000 -0.723 1
male 0.001 -0.320 0.058 1
NP1 0.014 -0.008 -0.056 0.004 1

NP2
 Standard

Model for standard prosthesis

Standard
Cycle Revision risk Death risk PrimaryTHR SuccessP RevisionTHR

0 1,000
1 0.00% 0.67% 1,000 -
2 0.00% 0.67% 993 -
3 0.00% 0.67% 987 -
4 0.00% 0.67% 980 -
5 0.00% 1.93% 961 -
6 0.00% 1.93% 943 -
7 0.00% 1.93% 924 -
8 0.00% 1.93% 907 -
9 0.00% 1.93% 889 -
10 0.00% 1.93% 872 -
11 0.00% 1.93% 855 -
12 0.00% 1.93% 839 -
13 0.00% 1.93% 822 -
14 0.00% 1.93% 806 -
15 0.00% 5.35% 763 -
16 0.00% 5.35% 723 -
17 0.00% 5.35% 684 -
18 0.00% 5.35% 647 -
19 0.00% 5.35% 613 -
20 0.00% 5.35% 580 -
21 0.00% 5.35% 549 -
22 0.00% 5.35% 519 -
23 0.00% 5.35% 492 -
24 0.00% 5.35% 465 -
25 0.00% 15.48% 393 -
26 0.00% 15.48% 332 -
27 0.00% 15.48% 281 -
28 0.00% 15.48% 237 -
29 0.00% 15.48% 201 -
30 0.00% 15.48% 170 -
31 0.00% 15.48% 143 -
32 0.00% 15.48% 121 -
33 0.00% 15.48% 102 -
34 0.00% 15.48% 87 -
35 0.00% 15.48% 73 -
36 0.00% 15.48% 62 -
37 0.00% 15.48% 52 -
38 0.00% 15.48% 44 -
39 0.00% 15.48% 37 -
40 0.00% 15.48% 32 -
41 0.00% 15.48% 27 -
42 0.00% 15.48% 23 -
43 0.00% 15.48% 19 -
44 0.00% 15.48% 16 -

Page 8
 Standard

45 0.00% 15.48% 14 -
46 0.00% 15.48% 12 -
47 0.00% 15.48% 10 -
48 0.00% 15.48% 8 -
49 0.00% 15.48% 7 -
50 0.00% 15.48% 6 -
51 0.00% 15.48% 5 -
52 0.00% 15.48% 4 -
53 0.00% 15.48% 4 -
54 0.00% 15.48% 3 -
55 0.00% 15.48% 3 -
56 0.00% 15.48% 2 -
57 0.00% 15.48% 2 -
58 0.00% 15.48% 2 -
59 0.00% 15.48% 1 -
60 0.00% 15.48% 1 -

Page 9
 Standard

Standard Prosthesis
SuccessR Death Check Cost Life-years QALYs

1,000 £ 394,000
- - 1,000 £ - 1,000 0
- 7 1,000 £ - 993 0
- 13 1,000 £ - 987 0
- 20 1,000 £ - 980 0
- 39 1,000 £ - 961 0
- 57 1,000 £ - 943 0
- 76 1,000 £ - 924 0
- 93 1,000 £ - 907 0
- 111 1,000 £ - 889 0
- 128 1,000 £ - 872 0
- 145 1,000 £ - 855 0
- 161 1,000 £ - 839 0
- 178 1,000 £ - 822 0
- 194 1,000 £ - 806 0
- 237 1,000 £ - 763 0
- 277 1,000 £ - 723 0
- 316 1,000 £ - 684 0
- 353 1,000 £ - 647 0
- 387 1,000 £ - 613 0
- 420 1,000 £ - 580 0
- 451 1,000 £ - 549 0
- 481 1,000 £ - 519 0
- 508 1,000 £ - 492 0
- 535 1,000 £ - 465 0
- 607 1,000 £ - 393 0
- 668 1,000 £ - 332 0
- 719 1,000 £ - 281 0
- 763 1,000 £ - 237 0
- 799 1,000 £ - 201 0
- 830 1,000 £ - 170 0
- 857 1,000 £ - 143 0
- 879 1,000 £ - 121 0
- 898 1,000 £ - 102 0
- 913 1,000 £ - 87 0
- 927 1,000 £ - 73 0
- 938 1,000 £ - 62 0
- 948 1,000 £ - 52 0
- 956 1,000 £ - 44 0
- 963 1,000 £ - 37 0
- 968 1,000 £ - 32 0
- 973 1,000 £ - 27 0
- 977 1,000 £ - 23 0
- 981 1,000 £ - 19 0
- 984 1,000 £ - 16 0

Page 10
 Standard

- 986 1,000 £ - 14 0
- 988 1,000 £ - 12 0
- 990 1,000 £ - 10 0
- 992 1,000 £ - 8 0
- 993 1,000 £ - 7 0
- 994 1,000 £ - 6 0
- 995 1,000 £ - 5 0
- 996 1,000 £ - 4 0
- 996 1,000 £ - 4 0
- 997 1,000 £ - 3 0
- 997 1,000 £ - 3 0
- 998 1,000 £ - 2 0
- 998 1,000 £ - 2 0
- 998 1,000 £ - 2 0
- 999 1,000 £ - 1 0
- 999 1,000 £ - 1 0
STDcost STDlys STDqalys
£ 394 21.35 0.00

Page 11
 NP1

Model for first new prosthesis

First New
Cycle Revision risk Death risk PrimaryTHR SuccessP RevisionTHR

0 1,000
1 0.00% 0.67% 1,000 -
2 0.00% 0.67% 993 -
3 0.00% 0.67% 987 -
4 0.00% 0.67% 980 -
5 0.00% 1.93% 961 -
6 0.00% 1.93% 943 -
7 0.00% 1.93% 924 -
8 0.00% 1.93% 907 -
9 0.00% 1.93% 889 -
10 0.00% 1.93% 872 -
11 0.00% 1.93% 855 -
12 0.00% 1.93% 839 -
13 0.00% 1.93% 822 -
14 0.00% 1.93% 806 -
15 0.00% 5.35% 763 -
16 0.00% 5.35% 723 -
17 0.00% 5.35% 684 -
18 0.00% 5.35% 647 -
19 0.00% 5.35% 613 -
20 0.00% 5.35% 580 -
21 0.00% 5.35% 549 -
22 0.00% 5.35% 519 -
23 0.00% 5.35% 492 -
24 0.00% 5.35% 465 -
25 0.00% 15.48% 393 -
26 0.00% 15.48% 332 -
27 0.00% 15.48% 281 -
28 0.00% 15.48% 237 -
29 0.00% 15.48% 201 -
30 0.00% 15.48% 170 -
31 0.00% 15.48% 143 -
32 0.00% 15.48% 121 -
33 0.00% 15.48% 102 -
34 0.00% 15.48% 87 -
35 0.00% 15.48% 73 -
36 0.00% 15.48% 62 -
37 0.00% 15.48% 52 -
38 0.00% 15.48% 44 -
39 0.00% 15.48% 37 -
40 0.00% 15.48% 32 -
41 0.00% 15.48% 27 -
42 0.00% 15.48% 23 -
43 0.00% 15.48% 19 -
44 0.00% 15.48% 16 -

Page 12
 NP1

45 0.00% 15.48% 14 -
46 0.00% 15.48% 12 -
47 0.00% 15.48% 10 -
48 0.00% 15.48% 8 -
49 0.00% 15.48% 7 -
50 0.00% 15.48% 6 -
51 0.00% 15.48% 5 -
52 0.00% 15.48% 4 -
53 0.00% 15.48% 4 -
54 0.00% 15.48% 3 -
55 0.00% 15.48% 3 -
56 0.00% 15.48% 2 -
57 0.00% 15.48% 2 -
58 0.00% 15.48% 2 -
59 0.00% 15.48% 1 -
60 0.00% 15.48% 1 -

Page 13
 NP1

First New Prosthesis

SuccessR Death Check Cost Life-years QALYs

1,000 £ 579,000
- - 1,000 £ - 1,000 0
- 7 1,000 £ - 993 0
- 13 1,000 £ - 987 0
- 20 1,000 £ - 980 0
- 39 1,000 £ - 961 0
- 57 1,000 £ - 943 0
- 76 1,000 £ - 924 0
- 93 1,000 £ - 907 0
- 111 1,000 £ - 889 0
- 128 1,000 £ - 872 0
- 145 1,000 £ - 855 0
- 161 1,000 £ - 839 0
- 178 1,000 £ - 822 0
- 194 1,000 £ - 806 0
- 237 1,000 £ - 763 0
- 277 1,000 £ - 723 0
- 316 1,000 £ - 684 0
- 353 1,000 £ - 647 0
- 387 1,000 £ - 613 0
- 420 1,000 £ - 580 0
- 451 1,000 £ - 549 0
- 481 1,000 £ - 519 0
- 508 1,000 £ - 492 0
- 535 1,000 £ - 465 0
- 607 1,000 £ - 393 0
- 668 1,000 £ - 332 0
- 719 1,000 £ - 281 0
- 763 1,000 £ - 237 0
- 799 1,000 £ - 201 0
- 830 1,000 £ - 170 0
- 857 1,000 £ - 143 0
- 879 1,000 £ - 121 0
- 898 1,000 £ - 102 0
- 913 1,000 £ - 87 0
- 927 1,000 £ - 73 0
- 938 1,000 £ - 62 0
- 948 1,000 £ - 52 0
- 956 1,000 £ - 44 0
- 963 1,000 £ - 37 0
- 968 1,000 £ - 32 0
- 973 1,000 £ - 27 0
- 977 1,000 £ - 23 0
- 981 1,000 £ - 19 0
- 984 1,000 £ - 16 0

Page 14
 NP1

- 986 1,000 £ - 14 0
- 988 1,000 £ - 12 0
- 990 1,000 £ - 10 0
- 992 1,000 £ - 8 0
- 993 1,000 £ - 7 0
- 994 1,000 £ - 6 0
- 995 1,000 £ - 5 0
- 996 1,000 £ - 4 0
- 996 1,000 £ - 4 0
- 997 1,000 £ - 3 0
- 997 1,000 £ - 3 0
- 998 1,000 £ - 2 0
- 998 1,000 £ - 2 0
- 998 1,000 £ - 2 0
- 999 1,000 £ - 1 0
- 999 1,000 £ - 1 0
NP1cost NP1lys NP1qalys
£ 579 21.35 0.00

Page 15