Cost-Effectiveness of Unicompartmental and Total Knee Arthroplasty in Elderly Low-Demand Patients

Abstract

Our model suggests that, on the basis of currently available cost and outcomes data, unicompartmental knee arthroplasty and total knee arthroplasty have similar cost-effectiveness profiles in the elderly low-demand patient population. However, several important parameters that could alter the cost-effectiveness analysis were identified; these included implant survival rates, costs, perioperative mortality and infection rates, and utility values achieved with each procedure. The thresholds identified in this study may help decision-makers to evaluate the cost-effectiveness of each strategy as further research characterizes the variables associate with unicompartmental and total knee arthroplasties and may be helpful for designing future appropriate clinical trials.

To Resurface or Not to Resurface the Patella in Total Knee Arthroplasty

“…Another strength of our study is that we used the McKnee modified health utility index which is a validated outcome instrument for the determination of health utilities [3] in patients with OA of the knee. Contrary to the EQ-5D index scores recently published [28] or other index scores based on the quality of well being [10,27], the McKnee specifically addresses the question of clinical marker health state scores in the TKA patient group, further substantiating our results. The results obtained from decision tree analyses depend on the accuracy of the available data in the literature; with the inclusion of randomized controlled trials only, we have minimized this potential confounding factor.…”

“…This explains the preference of some for not resurfacing; however, the current reoperation rate appears quite low. Given that the cost of a revision surgery is typically over $11,000 [20,27], and that less than half of patients benefit from secondary resurfacing, primary resurfacing appears to offer both cost and health utility advantages.…”

“…The disutility of having TKA was set at 0.1 as reported and validated previously [27]. Secondary resurfacing was likewise assessed a disutility of 0.1.…”

“…While secondary resurfacing might not be as invasive as the primary procedure, we consider secondary resurfacing as revision surgery and therefore not as benign as the index procedure, especially when taking into account the major impact a reoperation may impose on a patient [27]. A disutility of 0.1 for secondary resurfacing is less than would be associated with a full revision and greater than has been used for unicompartmental TKA (0.06) [27]. While we consider this value appropriate, we nevertheless evaluated the effect of a lower disutility by repeating the decision analysis with a disutility of 0.06 for secondary resurfacing.…”

Money matters: what to look for in an economic analysis

“…The article by Slover et al (2006) contains an example of a Markov decision model. This study analyzed the cost-effectiveness of unicompartmental and total knee arthroplasty in elderly patients.…”