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. 2021 Mar 9;31(1):9651.
doi: 10.4081/ejtm.2021.9651.

Health technology assessment through Six Sigma Methodology to assess cemented and uncemented protheses in total hip arthroplasty

Imma Latessa  1 , Carlo Ricciardi  2 , Deborah Jacob  3 , Halldór Jónsson Jr  4 , Monica Gambacorta  5 , Giovanni Improta  6 , Paolo Gargiulo  7
Affiliations

Health technology assessment through Six Sigma Methodology to assess cemented and uncemented protheses in total hip arthroplasty

Imma Latessa et al. Eur J Transl Myol. .

Abstract

The purpose of this study is to use Health Technology Assessment (HTA) through the Six Sigma (SS) and DMAIC (Define, Measure, Analyse, Improve, Control) problem-solving strategies for comparing cemented and uncemented prostheses in terms of the costs incurred for Total hip arthroplasty (THA) and the length of hospital stay (LOS). Multinomial logistic regression analysis for modelling the data was also performed. Quantitative parameters extracted from gait analysis, electromyography and computed tomography images were used to compare the approaches, but the analysis did not show statistical significance. The variables regarding costs were studied with the Mann-Whitney and Kruskal-Wallis tests. No statistically significant difference between cemented and uncemented prosthesis for the total cost of LOS was found, but the cost of the surgeon had an influence on the overall expenses, affecting the cemented prosthetic approach. The material costs of surgery for the uncemented prosthesis and the cost of theatre of surgery for the cemented prosthesis were the most influential. Multinomial logistic regression identified the Vastus Lateralis variable as statistically significant. The overall accuracy of the model is 93.0%. The use of SS and DMAIC cycle as tools of HTA proved that the cemented and uncemented approaches for THA have similar costs and LOSy.

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Conflict of interest statement

We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Figures

Fig 1.
Fig 1.
Surgical path of the patients
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Grants and funding

Funding: This research was supported jointly by the University of Reykjavik and the Icelandic National Hospital (Landspítali Scientific Fund, PI: Paolo Gargiulo, Title: Bone modeling inpatients undergoing THA, Project Number: A-2014-072) with additional funding support from Rannís (Rannís Icelandic Research Fund (Rannsóknasjodur), PI: Paolo Gargiulo, Title: Clinical evaluation score for Total Hip Arthroplasty planning and postoperative assessment, Project Number: 152368-051.

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