COST-BENEFIT ANALYSIS FOR DEVELOPING A COST-EFFECTIVE TERTIARY METASTATIC BONE DISEASE PATHWAY FOR COMPLEX PERIACETABULAR METASTASES

Patients with peri-acetabular bone metastases are currently treated by trauma services ad hoc, or by tertiary referral services such as sarcoma teams. These patients are high risk, with a significant complication rate, and benefit from a tertiary MDT approach. We aimed to assess the cost benefit of instituting a tertiary MBD service in a medium size DGH. This was a prospective modelling study estimating the cost of managing the MBD workload at a medium-sized orthopaedic centre (population 423,000) over a ten-year period (2026–2035). The cost-analysis projected cost differences in the following areas: implant cost, outpatient/inpatient care cost, intraoperative fracture rate and metalwork failure. In the study Health board (2026–2035), cancer prevalence will increase from 4528 to 8004 and the number of complex hip metastases will rise from 19 to 34/year. Instituting a tertiary MBD service will see implant costs rise from a mean of £94,536/year (baseline model) to £153,839 (total £593,026 over ten years). With more patients managed electively, patient care cost will fall from £2 million (baseline model) to £1.7 million in the MBD service (average saving of £29,748/year). Three metalwork failure scenarios were modelled versus the baseline projected 5% failure rate (13 with metalwork failure over ten years). A failure rate of 3% in the MBD service (8 patients) would save £222,634, 2% (5 patients) would save £333,951 and 1% (3 patients) would save £445,268. Overall, failure rates of 2% and 1% would favour an MBD service over the status quo (less expensive by £215/year 2% failure rate and £10,917/year 1% failure rate). This is the first cost-analysis to be performed on setting up a tertiary referral MBD service in a UK orthopaedic trauma unit. With a metalwork failure rate of 1% at five years, a tertiary MBD service would save £109,168 over ten years.