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Unlocking the potential of large observational databases, an illustration examining the relative merits of Cemented, Cementless and Hybrid Total Hip Replacements

Thursday 19 January 2012, 1.30PM to 2.30pm

Speaker(s): Dr Mark Pennington, London School of Hygiene and Tropical Medicine

Abstract: Observational databases have been under utilised in economic evaluation, perhaps because of fears that selection bias can potentially undermine the robustness of comparative analysis. However, large observational databases can have advantages over traditional RCTs where significant adverse events are rare and occur over a long time span. Failure of total hip prostheses are relatively uncommon, at least in the first ten years after operation. The NHS began collecting Patient Reported Outcome Measures (PROMs) on all patients receiving four elective procedures including Total Hip Replacement in 2009. In combination with Hospital Episode Statistics and the National Joint Register (the world's largest joint replacement register), these databases provide an ideal resource to compare the cost-effectiveness of different types of hip prosthesis. We undertake a comparison of the three main types of prosthesis and conclude that the most commonly chosen is not cost-effective. We probe the robustness of the comparison of quality of life with each prosthesis type using standard (OLS) regression and doubly robust methods incorporating GenMatching, an advance on propensity score matching.

Location: Alcuin A Block, A019/020

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