The interim results on estimation of a forefoot surgery quality-adjusted life years (QALY)?

R. Ahluwalia, N. Blucher, H. Kielghty, P. Weller, S. Platt, M. Hennessy

Introduction: Planned reduction in expenditure can be expected to result in rationing of NHS services. A method of assessing the financial benefit of a treatment is to estimate the quality-adjusted life years (QALY’s). The aim of this study was to perform a cost-utility analysis of forefoot surgery.

Methods: During a period between October 2011 and March 2012 all forefoot procedures were prospectively followed with the MOXFQ up to 1- year. We followed the health economic analysis as identified by Jenkins et al 2013. Health states derived from the MOXFQ were converted to a single summary index on a scale of -1 to 1, where 1 represents perfect health, and 0 represents no change. Using life expectancy tables we calculated the time spent in that state (in years) to derive the QALY’s gained or lost. Surgical costs were identified as per the HRG code to calculate the cost per QALY. Statistical analysis was undertaken to test the normality of data and 95% confidence intervals.

Results: 36 patients, with an average-age of 63.4yrs underwent forefoot surgery between Oct 2012- March 2012. All patients had hallux valgus correction with correction of lesser toe deformities and completed pre-operative MOXFQ and post-operative 1 year MOXFQ. We found a 33.4% (29.4-36.7%) positive improvement in MOXFQ at 1- year and identified the mean QALY gained is 4.9, as the average age at death on the Wirral 78.2 meaning any foot health improvement could potentially last 14.8 yrs. Our coding department identified the mean cost of surgery, was £3082.42 in this group and the mean lifetime cost-per-QALY is £733.90 if patient health remained static.

Conclusion: Forefoot surgery appears a cost-effective and compares favourably with both THR and TKR. We advocate further study into the QALY value for specific forefoot procedures and variance due to yearly change in NHS-payment structures.