Abstract
To evaluate the cost-effectiveness of a trial of nonoperative management versus early drilling in the treatment of skeletally immature patients with stable osteochondritis dissecans (OCD) of the knee. A decision tree model was used to compare the cost-effectiveness of a trial of nonoperative management versus early drilling (within 6 weeks of the first office visit) from payer and societal perspectives over a 3-year time horizon. Relevant transition probabilities, costs (in 2019 US dollars based on Medicare reimbursement), health state utilities, and times to healing were derived from the literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). One- and 2-way sensitivity analyses were performed on pertinent model parameters to validate the robustness of the base-case results using a conservative willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life-year (QALY). The Consolidated Health Economic Evaluation Reporting Standards checklist for reporting economic evaluations was used. In the base-case analysis from a payer perspective, early drilling was more effective (2.51 versus 2.27 QALYs), more costly ($4,655 versus $3,212), and overall more cost-effective (ICER $5,839/QALY) relative to nonoperative management. In the base-case analysis from a societal perspective, early drilling dominated nonoperative management owing to its increased effectiveness (2.51 versus 2.27 QALYs) and decreased cost ($13,098 versus $18,149). These results were stable across broad ranges on sensitivity analysis. Based on 1-way threshold analyses from a payer perspective, early drilling remained cost-effective as long it cost less than $19,840, the disutility of surgery was greater than -0.40, or the probability of successful early drilling was greater than 0.62. Although the traditional approach to stable OCD lesions of the knee in skeletally immature patients has been a trial of nonoperative management, our data suggest that early drilling may be cost-effective from both payer and societal perspectives. III, economic and decision analysis.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
More From: Arthroscopy: The Journal of Arthroscopic and Related Surgery
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.