Cost-effectiveness Of Total Knee Arthroplasty Research Articles

Cost-utility analysis of total knee arthroplasty alone and in comparison with post-surgical rehabilitation and conservative treatment in the Republic of Kazakhstan

BackgroundDespite ample international knowledge on cost-effectiveness of total knee arthroplasty (TKA), it has never been a subject of investigation in Kazakhstan or other post-Soviet economies. Our study aimed to carry-out the cost-utility analysis of TKA alone and in comparison with post-surgical rehabilitation and conservative treatment at health care facilities of Kazakhstan.MethodsTwo hundred and forty four patients with knee osteoarthritis (KOA) who underwent TKA in orthopedic departments of Almaty, Nur-Sultan and Semey hospitals between January 1, 2019 and September 30, 2019 were followed-up for 12 months. The health-related quality of life was measured by the EQ-5D utility and Western Ontario and McMaster Universities Osteoarthritis Index was used to measure the patients’ health status. The costs were estimated from the view of health care provider. We calculated the cost per QALY, the Cost-Utility Ratio and the Incremental Cost-Effectiveness Ratio.ResultsAt the time of 12-month follow-up patients who received TKA alone or with the course of rehabilitation showed benefit over patients from the group of conservative treatment in terms of overall health status. Mean QALY gained at 12 months constituted 1.66 for the group that received TKA with rehabilitation, 1.48 for the group that received TKA alone and 0.24 for the group that received conservative treatment. Mean cost per QALY gained was USD 30 795.75 for KOA patients under conservative treatment, USD 6 323.69 for KOA patients subjected to TKA and USD 2 670.32 for KOA patients with rehabilitation course after TKA.ConclusionBoth TKA and TKA with rehabilitation could be considered as highly cost-effective interventions. The data obtained could be of interest for policy makers, medical professionals and KOA patients.

Cost-Effectiveness of Total Knee Arthroplasty vs Nonoperative Management in Normal, Overweight, Obese, Severely Obese, Morbidly Obese, and Super-Obese Patients: A Markov Model

BackgroundWe estimated the cost-effectiveness of performing total knee arthroplasty (TKA) vs nonoperative management (NM) among 6 body mass index (BMI) cohorts. MethodsA Markov model was used to compare the cost-utility of TKA and NM in 6 BMI groups (nonobese [BMI 18.5-24.9], overweight [25-29.9], obese [30-34.9], severely obese [35-39.9], morbidly obese [40-49.9], and super-obese [50+] patients) over a 15-year period. Model parameters for transition probability (ie, revision, re-revision, death), utility, and costs were estimated from the literature. Direct medical costs but not indirect societal costs were included in the model. Costs and utilities were discounted 3% annually. The primary outcome was the incremental cost-effectiveness ratio (ICER) of TKA vs NM. One-way and probabilistic sensitivity analyses of the model parameters were performed to determine the robustness of the model. ResultsOver the 15-year period, the ICERs for the TKA vs NM for the different BMI categories were nonobese ($3317/quality-adjusted life years [QALYs]), overweight ($2837/QALY), obese ($2947/QALY), severely obese ($3536/QALY), morbidly obese ($5531/QALY), and super-obese ($11,878/QALY). The higher BMI groups tended to have higher incremental QALYs and also higher incremental costs. The probabilistic sensitivity analysis with an ICER threshold of $30,000/QALY showed that TKA would be cost-effective in 100% of simulations of patients with a BMI<50 and 99.16% of super-obese simulations. ConclusionWhile performing TKA on super-obese patients is more expensive, the substantial improvements in patient outcomes make it cost-effective. Therefore, withholding TKA care based on a BMI would lead to an unjustified loss of health-care access.

Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy

To compare the age-based cost-effectiveness of total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and high tibial osteotomy (HTO) for the treatment of medial compartment knee osteoarthritis (MCOA). A Markov model was used to simulate theoretical cohorts of patients 40, 50, 60, and 70years of age undergoing primary TKA, UKA, or HTO. Costs and outcomes associated with initial and subsequent interventions were estimated by following these virtual cohorts over a 10-year period. Revision and mortality rates, costs, and functional outcome data were estimated from a systematic review of the literature. Probabilistic analysis was conducted to accommodate these parameters' inherent uncertainty, and both discrete and probabilistic sensitivity analyses were utilized to assess the robustness of the model's outputs to changes in key variables. HTO was most likely to be cost-effective in cohorts under 60, and UKA most likely in those 60 and over. Probabilistic results did not indicate one intervention to be significantly more cost-effective than another. The model was exquisitely sensitive to changes in utility (functional outcome), somewhat sensitive to changes in cost, and least sensitive to changes in 10-year revision risk. HTO may be the most cost-effective option when treating MCOA in younger patients, while UKA may be preferred in older patients. Functional utility is the primary driver of the cost-effectiveness of these interventions. For the clinician, this study supports HTO as a competitive treatment option in young patient populations. It also validates each one of the three interventions considered as potentially optimal, depending heavily on patient preferences and functional utility derived over time.

Cost-effectiveness of Total Knee Arthroplasty in the United States

Total knee arthroplasty (TKA) relieves pain and improves quality of life for persons with advanced knee osteoarthritis. However, to our knowledge, the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness have not been investigated in the United States. We developed a Markov, state-transition, computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. We projected lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume. Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations. Finally, we conducted sensitivity analyses to determine various parameters' influences on cost-effectiveness. Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life years (QALYs). Lifetime costs rose from $37,100 (no TKA) to $57 900 after TKA, resulting in an incremental cost-effectiveness ratio of $18,300 per QALY. For high-risk patients, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28,100 per QALY. At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers. Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges. The greatest variations were seen for the quality of life gain after TKA and the cost of TKA. Total knee arthroplasty appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs performed in a high-volume hospital confer even greater value per dollar spent than TKAs performed in low-volume centers.

Cost-effectiveness of Total Knee Arthroplasty in the United States—Invited Commentary

Cost-effectiveness of Total Knee Arthroplasty in the United States—Invited Commentary