" /> My Title page contents

Societal Benefits Of THA

This study again demonstrates the economic benefits to society of appropriate joint replacement surgery. Let’s hope that CMS recognizes this value and puts policies in place to fairly compensate orthopedic surgeons for this complex and labor intensive surgery. If not, the supply of qualified surgeons will diminish making this procedure less available to those who need it. 

Estimating the Societal Benefits of THA After Accounting for Work Status and Productivity: A Markov Model Approach

Lane Koenig PhD, Qian Zhang PhD, Matthew S. Austin MD, Berna Demiralp PhD, Thomas K. Fehring MD, Chaoling Feng PhD, Richard C. Mather MD, Jennifer T. Nguyen MPP, Asha Saavoss BA, Bryan D. Springer MD, Adolph J. Yates MD


Demand for total hip arthroplasty (THA) is high and expected to continue to grow during the next decade. Although much of this growth includes working-aged patients, cost-effectiveness studies on THA have not fully incorporated the productivity effects from surgery.


We asked: (1) What is the expected effect of THA on patients’ employment and earnings? (2) How does accounting for these effects influence the cost-effectiveness of THA relative to nonsurgical treatment?


Taking a societal perspective, we used a Markov model to assess the overall cost-effectiveness of THA compared with nonsurgical treatment. We estimated direct medical costs using Medicare claims data and indirect costs (employment status and worker earnings) using regression models and nonparametric simulations. For direct costs, we estimated average spending 1 year before and after surgery. Spending estimates included physician and related services, hospital inpatient and outpatient care, and postacute care. For indirect costs, we estimated the relationship between functional status and productivity, using data from the National Health Interview Survey and regression analysis. Using regression coefficients and patient survey data, we ran a nonparametric simulation to estimate productivity (probability of working multiplied by earnings if working minus the value of missed work days) before and after THA. We used the Australian Orthopaedic Association National Joint Replacement Registry to obtain revision rates because it contained osteoarthritis-specific THA revision rates by age and gender, which were unavailable in other registry reports. Other model assumptions were extracted from a previously published cost-effectiveness analysis that included a comprehensive literature review. We incorporated all parameter estimates into Markov models to assess THA effects on quality-adjusted life years and lifetime costs. We conducted threshold and sensitivity analyses on direct costs, indirect costs, and revision rates to assess the robustness of our Markov model results.


Compared with nonsurgical treatments, THA increased average annual productivity of patients by USD 9503 (95% CI, USD 1446–USD 17,812). We found that THA increases average lifetime direct costs by USD 30,365, which were offset by USD 63,314 in lifetime savings from increased productivity. With net societal savings of USD 32,948 per patient, total lifetime societal savings were estimated at almost USD 10 billion from more than 300,000 THAs performed in the United States each year.


Using a Markov model approach, we show that THA produces societal benefits that can offset the costs of THA. When comparing THA with other nonsurgical treatments, policymakers should consider the long-term benefits associated with increased productivity from surgery.

Level of Evidence

Level III, economic and decision analysis.




  1. Hi, I think your site might be having browser compatibility issues.
    When I look at your blog site in Firefox, it looks fine but when opening in Internet Explorer, it has some
    overlapping. I just wanted to give you a quick heads up!

    Other then that, fantastic blog!

  2. Please let me know if you’re looking for a article writer for your blog.
    You have some really good posts and I believe I would be a good
    asset. If you ever want to take some of the load off, I’d really like to write some articles for your blog in exchange for a link back to mine.

    Please send me an e-mail if interested. Thank you!

  3. What i do not realize is in fact how you’re not actually
    a lot more well-liked than you may be now. You’re
    so intelligent. You realize therefore considerably in relation to this topic,
    produced me individually imagine it from a lot of varied angles.
    Its like women and men don’t seem to be involved except it is something to accomplish with Lady gaga!
    Your individual stuffs outstanding. At all times care for it up!

  4. Great work! That is the type of info that are meant to be shared around the internet.
    Disgrace on the seek engines for not positioning this post upper!
    Come on over and consult with my website . Thanks =)

  5. I’m truly enjoying the design and layout of your site.
    It’s a very easy on the eyes which makes it much more enjoyable for me to come here and visit more often. Did you hire out a
    developer to create your theme? Fantastic work!

  6. Wonderful beat ! I would like to apprentice while you amend your web site, how could i subscribe for a blog site?
    The account aided me a acceptable deal. I had been tiny bit acquainted of this your broadcast offered bright clear concept

  7. First off I want to say fantastic blog! I had a quick
    question that I’d like to ask if you do not mind. I was
    interested to know how you center yourself and clear your thoughts before writing.

    I have had difficulty clearing my mind in getting my ideas out.

    I do enjoy writing however it just seems like the first
    10 to 15 minutes are usually wasted just trying to figure out how to
    begin. Any recommendations or hints? Cheers!

  8. Hi I am so grateful I found your weblog, I really found you by mistake, while I
    was researching on Bing for something else, Regardless I am here now and would just
    like to say thanks a lot for a incredible post and a
    all round thrilling blog (I also love the theme/design), I don’t have time to go through it all at the
    moment but I have bookmarked it and also added your RSS feeds,
    so when I have time I will be back to read much more,
    Please do keep up the awesome work.

  9. Do you have a spam issue on this blog; I also am a blogger,
    and I was wanting to know your situation; we have created some nice procedures and we are looking to trade strategies with other folks, why not shoot me an e-mail if interested.

  10. That is really interesting, You are a very professional blogger.
    I have joined your rss feed and stay up for in the hunt for more of your
    fantastic post. Also, I have shared your site in my social networks

  11. Aw, this was an extremely good post. Finding the time and actual effort to generate a great
    article… but what can I say… I put things off a whole lot
    and never seem to get nearly anything done.

  12. Simply wish to say your article is as amazing. The clarity in your post is simply cool
    and i could assume you are an expert on this
    subject. Fine with your permission let me to grab your feed to keep up to date with forthcoming post.
    Thanks a million and please carry on the enjoyable work.

  13. Fantastic blog you have here but I was curious
    if you knew of any discussion boards that cover the same topics discussed here?

    I’d really love to be a part of group where I can get feedback from
    other experienced individuals that share the same interest.
    If you have any suggestions, please let me know.
    Many thanks!

  14. I just wanted to write a small message to say thanks to you for all of the nice pointers you are posting here. My prolonged internet search has at the end of the day been compensated with wonderful ideas to go over with my family members. I ‘d point out that we website visitors are extremely endowed to be in a remarkable place with many awesome professionals with helpful ideas. I feel really blessed to have encountered your website and look forward to plenty of more exciting times reading here. Thanks once more for a lot of things.

  15. Hello, i think that i saw you visited my weblog thus i came to “return the favor”.I am trying to find things to improve my web site!I suppose its ok to use some of your ideas!!

  16. An interesting discussion is worth comment. I do think that you need to
    write more about this topic, it may not be a taboo matter but generally people don’t discuss such issues.
    To the next! Many thanks!!

Leave a Comment