Cost-effectiveness of Total Knee Arthroplasty in the United States

Background Preoperative depressive symptoms have been shown in some but not all studies to be associated with poor self-reported pain and function outcomes. In addition, depressive symptoms after surgery have been shown to improve relative to preoperative levels.Questions/purposes We hypothesized that (1) preoperative depressive symptoms would predict postoperative pain; (2) depressive symptoms would decrease after surgery; and (3) preoperative depressive symptoms would increase as the scheduled surgery date approached. Methods Data from the Osteoarthritis Initiative, a National Institutes of Health-funded prospective multiyear cohort study, were used in this retrospective analysis. Persons from four communities were eligible if they had radiographic knee osteoarthritis or were at risk for developing knee osteoarthritis based on occupational, medical history, or body weight risk factors. A total of 4796 persons participated and rates of followup were 80% or greater over the course of the study. Participants completed a validated depressive symptom scale and the Knee Injury and Osteoarthritis Outcome Scale pain scale each year for 3 years before and 3 years after TKA. Latent growth curve modeling was used to model intercepts and slopes of preand postoperative depression and pain. Preoperative trajectories and intercepts were then used to predict postoperative pain and depressive symptoms adjusting for confounding variables. Results After adjustment for potential confounding, we found no evidence that preoperative depressive symptoms predicted postoperative pain with function (estimate, 0.1; 95% confidence interval, À0.31 to 0.50; p = 0.64) or that depressive symptoms were reduced after surgery Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. The Osteoarthritis Initiative (OAI) is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262), funded by the National Institutes of Health (NIH), a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation; GlaxoSmithKline; and Pfizer, Inc. Private-sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public-use data set and does not necessarily reflect the opinions or views of the OAI Investigators, the NIH, or the private funding partners. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that...

Section: Introductionmentioning

confidence: 99%

What Is the Relationship Between Depressive Symptoms and Pain During Functional Tasks in Persons Undergoing TKA? A 6-year Perioperative Cohort Study

Riddle

Perera

Nay

et al. 2015

“…TKA is a cost-effective and increasingly common procedure used to treat arthritis of the knee [15,18]. Demand for primary TKA is increasing and projected to grow by 673% by 2030 [14].…”

Section: Introductionmentioning

confidence: 99%

Decreased Length of Stay After TKA Is Not Associated With Increased Readmission Rates in a National Medicare Sample

Vorhies

Wang

Herndon

et al. 2012

Background There is a trend toward decreasing length of hospital stay (LOS) after TKA although it is unclear whether this trend is detrimental to the overall postoperative course. Such information is important for future decisions related to cost containment. Questions/purposes We determined whether decreases in LOS after TKA are associated with increases in readmission rates. Patients and MethodsWe retrospectively reviewed the rates and reasons for readmission and LOS for 4057

“…Very few studies compare the cost utility of joint arthroplasty when chosen over nonoperative intervention in degenerative joint disease. Losina et al [31] and Ruiz et al [47] quantify the cost utility of TKA versus nonoperative intervention for the knee. Losina et al [31] assessed TKA versus nonoperative management and also evaluated the influence of patient risk and hospital volume on cost-effectiveness.…”

Section: Cost Utility Of Tjamentioning

confidence: 99%

“…Losina et al [31] and Ruiz et al [47] quantify the cost utility of TKA versus nonoperative intervention for the knee. Losina et al [31] assessed TKA versus nonoperative management and also evaluated the influence of patient risk and hospital volume on cost-effectiveness. The authors found that compared with a nonoperative strategy, TKA in the base case was associated with an incremental cost-effectiveness ratio of USD 18,300 per QALY.…”

Section: Cost Utility Of Tjamentioning

confidence: 99%

“…The study did not, however, delineate the proportion of these studies performed in the United States. A 2009 cost utility analysis in TKA suggested that the majority of prior economic analyses for TKA had been focused on non-US populations [31]. To the authors' knowledge there is no prior systematic review of the TJA cost utility analysis literature that had a specific emphasis on the US population.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Current Status of Cost Utility Analyses in Total Joint Arthroplasty: A Systematic Review

Nwachukwu

Bozic

Schairer

et al. 2015

101

Background Total joint arthroplasty (TJA), although considered to be highly beneficial, is associated with substantial costs to the US healthcare system. Cost utility analysis has become an increasingly important means to objectively evaluate the value of a healthcare intervention from the perspective of both extending the quantity and improving the quality of life. Relatively little is known about the overall cost utility analysis evidence base in TJA. Questions/purposes The goals of this review were to (1) determine the cost utility of TJA interventions; (2) critically assess the quality of published US-based cost utility analyses using the Quality of Health Economic Studies instrument; and (3) determine what characteristics were common among studies receiving a high quality score. Methods A systematic review of the literature using the MEDLINE database was performed to compile findings and critically appraise US-based cost utility analysis studies for total hip and knee arthroplasty. Based on review of 676 identified articles, 23 studies were included. We used the Quality of Health Economic Studies instrument to assess study quality and one-sided Fisher's exact tests were applied to analyze the predictors of high-quality cost utility analysis. Results Very few studies compare the cost utility of TJA versus nonoperative intervention; however, the available evidence suggests that TJA can be cost-saving and is highly cost-effective compared with conservative management of end-stage arthritis. The majority of identified studies are focused on the cost utility of new implant technologies or comparisons among surgical alternatives. These studies suggest that the upfront costs associated with new technologies are cost-effective when there is a major reduction in a future cost. The quality of identified studies is quite high (Quality of Health Economic Studies Instrument score: mean 86.5; range, 63-100). National funding source (p = 0.095) and lifetime horizon for analysis (p = 0.07) correlate with high-quality evidence but do not reach significance.