Abstract
BackgroundThere is an ongoing debate regarding optimal fixation of total knee arthroplasty (TKA), however cost has not been addressed as profoundly. Therefore, the current study primarily aimed to compare costs and cost-effectiveness 1 year after cemented or uncemented TKA. A secondary objective was to compare short-term functional outcomes between both groups.MethodsA posthoc prospective observational multicenter cohort study of 60 cemented and 50 uncemented Low Contact Stress (LCS) knee systems. Outcome was evaluated using the EuroQol5D-3 L (EQ5D) index, in order to calculate quality adjusted life years (QALYs). Total costs were calculated considering direct costs within the hospital setting (inpatient cost) as well as direct and indirect costs outside the hospital. Cost-effectiveness (total costs per QALY), Oxford Knee Score (OKS) and Numeric Rating Scale (NRS) were compared between cemented and uncemented cases at 1 year after surgery. HealthBASKET project, a micro-costing approach, represents the Dutch costs and situation and was used to calculate hospital stay. (In) direct costs outside the healthcare (medical cost and productivity cost) were determined using two validated questionnaires.ResultsMedian costs per QALY were similar between cemented and uncemented TKA patients (€16,269 and €17,727 respectively; p = 0.50). Median OKS (44 and 42; p = 0.79), EQ5D (0.88 and 0.90; p = 0.82) and NRS for pain (1.0 and 1.0; p = 0.48) and satisfaction (9.0 and 9.0; p = 0.15) were also comparable between both groups.ConclusionFor this type of knee implant (LCS), inpatient hospital costs and costs after hospitalization were comparable between groups.
Highlights
There is an ongoing debate regarding optimal fixation of total knee arthroplasty (TKA), cost has not been addressed as profoundly
The current study demonstrated, in a post-hoc analysis using both cemented and uncemented components of the same TKA design, comparable average costs and cost-effectiveness per patient up to 1 year after the index surgery
Even though we found higher median costs per Quality adjusted life years (QALY) in the uncemented group, interquartile ranges were wide and differences were statistically insignificant (p = 0.50)
Summary
There is an ongoing debate regarding optimal fixation of total knee arthroplasty (TKA), cost has not been addressed as profoundly. A recent analysis by Lawrie et al found no differences between both modes of fixation when comparing procedural costs of publicly available data on prices of cement and implants in the United States and time of surgery [9]. Another cost comparison between both fixation methods resulted in higher inpatient costs of uncemented fixation but a shorter length of stay and higher odds of being discharged home [10]. These conflicting results, urged us to evaluate whether both direct and indirect in-patient and out-patient costs were higher in uncemented TKA patients
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