Hiqa: Many hip and knee ops aren’t cost-effective

Elderly people could soon find it more difficult to get hip and knee operations under new recommendations which say many of these are not “cost-effective”.

As part of its ongoing health technology assessments of a series of non-life-threatening surgeries, Hiqa, the State’s health watchdog, has suggested some hip and knee operations are not cost-effective.

This is because of the level of quality-of-life improvement they bring to certain people, and the fact other, more practical, non-surgical options may be available.

As such, it has suggested doctors should treat patients “more conservatively” in order to bring down costs and ensure only people who need the procedures most receive them, freeing resources up for other areas.

The plan, which is open to public consultation until May 28, has not yet been ratified by the Department of Health or the HSE.

According to the reports, hip arthroplasty procedures — which involve partial or full hip replacements — cost an average of €11,403 per case and the State a total of €37.3m a year. They most commonly involve people with osteoarthritis, a condition which is set to increase significantly due to Ireland’s ageing population.

While the report stressed that “all patients should have timely access to routine investigations via primary care services”, it said the majority of people “should be managed conservatively in the first instance”.

A similar conclusion has been made for knee operations. It has been recommended that the majority of patients should be discouraged from the procedures.

This position, Hiqa suggests, should only change if the condition “has not improved following at least three months of conservative management”, and if there is “moderate to severe functional limitation significantly affecting their quality of life”.

While it said the “exact nature” of the conservative approach has not yet been outlined, it should include “weight reduction, activity programmes, physiotherapy, shoewear modification, and/or advice in relation to activities of daily living”.

Dr Mairin Ryan, Hiqa’s director of health technology assessment, said: “The purpose of these [recommendations] is to ensure the right patients receive referral at the right time and, in particular, that unnecessary referral is avoided in those people who are unlikely to get additional benefit from surgery.”

She added: “Fair and equal access to these surgeries, as well as the needs and expectations of individual patients, needs to be balanced with the requirement to maximise health gain for the population as a whole.”