Abstract
ObjectiveIn end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed.MethodsA treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves.ResultsStarting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90–95% for the younger age categories.ConclusionA treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient.
Highlights
In the event of failure of conservative treatment in generalized knee osteoarthritis the treatment of choice is often a total knee arthroplasty (TKA)
A treatment strategy starting with TKA and a strategy starting with knee joint distraction (KJD) for patients of different age and gender was simulated
Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant in about 80% of simulations in these age categories when compared to TKA
Summary
In the event of failure of conservative treatment in generalized knee osteoarthritis the treatment of choice is often a total knee arthroplasty (TKA). TKA is generally regarded as the gold standard for generalized knee osteoarthritis, being a safe and (cost)-effective procedure [1]. In younger and middle aged patients there are some legitimate concerns regarding the effectiveness of TKA related to the time to failure of TKA and need for revision surgery [2]. For young and middle aged patients with generalized knee osteoarthritis alternative treatment strategies are needed. One of those alternatives is knee joint distraction (KJD). KJD is a surgical procedure in which an external fixation frame is used to extend the tibio-femoral joint for 6–8 weeks
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