Comparing performance, costs and current practice for hip replacement implants

Disease - Osteoarthritis, joint replacement

Lead applicant - Ms Charlotte Davies

Organisation - University of East Anglia

Type of grant - Foundation Fellowship

Status of grant - Active

Amount of the original award - £126,319

Start date - 5 September 2011

Reference - 19439

Public Summary

What are the aims of this research?

We aim to investigate the relationship between the hip implant industry and the NHS. We will look at costs, surgeon choice and current policies, to find out if current practice achieves the best value for money.

Why is this research important?

About 8 million people in the UK have osteoarthritis. For those with end stage disease in the hip, the only effective treatment is hip replacement surgery. Over 70,000 operations were carried out in England and Wales in 2008/9; this number has almost doubled in the last decade. As the population continues to age, demand for this type of surgery will continue to rise. This will have significant implications for the health system in terms of how it manages this rising cost.

It is important that current hip implants are clinically effective, but we still need to encourage new developments to improve the quality of future implants. A competitive hip implant market will help to achieve this. We need to find out if the NHS has access to the best quality and range of implants, at the appropriate price. We want to make sure the current policy of paying hospitals for surgery, at a set value, is in the best interest of all parties: patient, hospital and manufacturer.

This study will explore the hip implant market in terms of the number of effective competitors, the range of products, manufacturer size and how easy it is for new manufacturers to enter the market. We will use data from the National Joint Registry and Hospital Episode Statistics databases to find out if patients receive the best ‘value-for-money’ implants. How do surgery costs vary between different types of patients and hospitals? Is there is an ideal way for the NHS to buy hip implants from the manufacturers so as to counteract their market power? We will also find out if the current surgery payment policy limits the choice of implants available to surgeons.

How will the findings benefit patients?

This research will help to further develop the guidance on the hip implant industry; benefiting patients, hospitals and the manufacturing industry. It will also contribute to a growing debate on how to evaluate medical devices. The ultimate aim is that patients should receive the best quality implant given the constraints of the NHS budget.