Cost-effectiveness analysis of Coblation versus mechanical shaver debridement in patients following knee chondroplasty

Ayoade Adeyemi,Paul Trueman,Anil Ranawat,Leo Nherera

doi:10.1186/s12962-020-00240-w

Abstract

BackgroundTo compare costs and outcomes following knee chondroplasty with Coblation versus mechanical shaver debridement (MSD) in patients with grade III articular cartilage lesions of the knee.MethodsA decision-analytic model was developed to compare costs and outcomes of the two methods from a US payer perspective. We used published clinical data from a single-center randomized clinical trial (RCT) designed to compare outcomes between Coblation and MSD in patients with grade III articular cartilage lesions of the medial femoral condyle. Following primary knee chondroplasty, patients experienced either treatment success (no additional surgery required) or required a revision over the 4 year follow-up period. Costs associated with the initial chondroplasty, physical therapy sessions through the 6 week postoperative period, and revision rates at 4 years post-surgery were estimated using 2018 US Medicare Physician Fee Schedule. Sensitivity analyses including a 10 year time horizon and threshold analyses were performed to test the robustness of the model.ResultsThe estimated total cost per patient was $4614 and $7886 for Coblation and MSD, respectively, resulting in cost-savings of $3272 in favor of Coblation, making it a dominant strategy because of lower costs and improved clinical outcomes. Threshold analysis showed that Coblation remained dominant even when revision rates were assumed to increase from the base case rate of 14–66%. Sensitivity analyses showed that cost-saving results were insensitive to variations in revision rates, number of physical therapy sessions and the time horizon used.ConclusionCoblation chondroplasty is a cost-saving procedure compared with MSD in the treatment of patients with grade III articular cartilage lesions of the knee.

Highlights

Chondral defects of the knee joint are common [1, 2] and may result in functional impairment and adversely affect quality of life, generating considerable costs to society [3]
We evaluated the costs and outcomes associated with Coblation compared with mechanical shaver debridement (MSD) following a knee chondroplasty procedure
Over the 4 year post-operative period, the model estimated that the total cost per patient was $4614 for patients treated with Coblation and $7886 for patients treated with MSD resulting in cost-savings of $3272 in favor of Coblation

Summary

Introduction

Chondral defects of the knee joint are common [1, 2] and may result in functional impairment and adversely affect quality of life, generating considerable costs to society [3]. Interventions that repair or treat cartilage defects may help reduce the economic burden of osteoarthritis. These interventions include surgical procedures which until as recent as 2007, had not received the deserved attention due to perceived lack of cost-effectiveness evidence [9]. Numerous studies have reported the potential benefits of radiofrequency-based ablation therapies for knee chondroplasty [10, 14]. These studies have shown that radiofrequency-based therapies prevent damage to the cartilage and provide a smoothing effect without further fibrillation. To compare costs and outcomes following knee chondroplasty with Coblation versus mechanical shaver debridement (MSD) in patients with grade III articular cartilage lesions of the knee

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