Introduction: Heterotopic ossification (HO) is a known complication in hip surgery, but there is still uncertainty whether to use non-steroidal anti-inflammatory drugs (NSAID) or radiation in its prevention. While the literature focuses almost exclusively on (as it turns out the lacking) difference in effectiveness, one important difference that has been widely unacknowledged thus far is cost-effectiveness.
Method: We systematically reviewed the literature to extract evidence-based estimates of treatment effectiveness, complications, and associated costs. These variables are combined in a decision tree to calculate costs for all potential outcomes and tested in sensitivity analyses. Finally, the incremental cost-effectiveness ratio (ICER) was calculated. Data on the effectiveness of both treatments could be extracted from nine randomized controlled trails and one meta-analysis.
Results: Across the 95% confidence interval for the risk difference of HO despite treatment radiation is either dominated by NSAID, which are cheaper and more effective, or has an ICER of US$ 5,858.93 per additionally prevented case of HO.
Conclusion: Among the studied variables that might affect cost-effectiveness, the rate of complications requiring treatment was by far the most influential.