• Ajay Premkumar, Drake G Lebrun, Sreetha Sidharthan, Caitlin L Penny, Emily R Dodwell, Alexander S McLawhorn, and Benedict U Nwachukwu.
• Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
• J Arthroplasty. 2020 Jul 1; 35 (7): 1766-1775.e3.

BackgroundThe cost-effectiveness of bariatric surgery to achieve weight loss prior to total hip arthroplasty (THA), and decrease the complications and costs associated with THA in the morbidly obese, is unknown. This study evaluated the cost-effectiveness of bariatric surgery prior to THA for morbidly obese patients with end-stage hip osteoarthritis (OA).MethodsA state-transition Markov model was constructed to compare the cost-utility of 2 treatment protocols for patients with morbid obesity and end-stage hip OA: (1) immediate THA and (2) bariatric surgery 2 years prior to THA (combined protocol). The analysis was performed from both a payer and a societal perspective using direct and indirect costs over a 40-year time horizon. Utilities, associated costs, and probabilities for health state transitions were derived from the literature. One-way, 2-way and probabilistic sensitivity analyses were performed to validate the robustness of the base case results, using the standard willingness-to-pay threshold of $100,000/quality-adjusted life years.ResultsFrom the societal perspective, the combined protocol was more effective (13.16 vs 12.26) with less cost ($91,717 vs $92,684) and thus was the dominant strategy over immediate THA. These results were stable across broad ranges for independent model variables. Monte Carlo simulation with 100,000 samples demonstrated that bariatric surgery prior to THA was the preferred cost-effective strategy over 95% of the time from both a societal and payer perspective.ConclusionIn the morbidly obese patient with end-stage hip OA, bariatric surgery prior to THA is a cost-effective strategy for improving quality of life and decreasing societal and payer costs.Level Of EvidenceII.Copyright © 2020 Elsevier Inc. All rights reserved.

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