Comparing patient health outcomes and treatment thresholds in England and Germany - the case of hip replacement

Summary: Total hip replacement is a highly effective and cost-effective surgical procedure to alleviate pain and improve patients’ health-related quality of life. But there are concerns about who should receive the procedure. In Germany, the number of hip replacements per inhabitant is approximately 60% higher in Germany than in England and is the highest in the European Union. This has led German health insurance companies to ask whether health care providers operate on too many patients, some of whom might not need surgery at all.

The aim of this paper is to compare patients in England and Germany in terms of their a) health status before hip replacement surgery and b) changes in their health status after surgery. In England we use data from the national patient-reported outcome measures (PROMs) program, which collects PROM data before and after surgery for all patients treated in the NHS. In Germany data were collected as part of a prospective study in a large orthopaedic hospital. We use a measure of health status known as the EuroQoL-5D (EQ-5D).

We find that German patients say that they are in better health before surgery than their English counterparts. This is most pronounced in the EQ-5D health dimensions mobility and usual activities, where nearly 33% of German patients report having no problems compared to 6% in England.

The change in health status after surgery is smaller for German than English patients. This is probably because German patients were healthier in the first place. If we compare German and English patients with a similar health status before surgery, the improvements they experience are similar.

In summary, our results suggest that total hip replacement is equally effective in both countries but patients in Germany are in better health before they are operated on.

Download the paper from the Quality of Life Research Journal.