Is It Worth Delaying Total Knee Replacement as Late as Possible? A Cost-Effectiveness Analysis Using a Markov Model in the Indian Setting

George, Jaiben; Gautam, Deepak; Devasenapathy, Niveditha; Malhotra, Rajesh

doi:10.1016/j.vhri.2020.12.009

Cited by 6 publications

(29 citation statements)

References 48 publications

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“…This systematic review assessed the models used in cost utility or cost-effectiveness of the 29 included studies, out of which, sixteen studies reported methodology to determine costeffectiveness. Eight studies used Markov model (5,7,18,23,24,27,29,37) whereas five studies reported regression model (6,33,34,36,38). One study each reported Marginal structure model (28), discrete simulation model (32) and decision tree analysis (8) Of the 29 included studies in our systematic review, 23 studies used direct cost of TKR in the cost effectiveness analysis through Markov model.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the high cost of TKR in developed countries, the TKR surgery was found to be cost effective than non-surgical management for OA knee (23). Similarly, the TKR surgery in developing country like India was also found to be cost effective (7). So, when the economic condition in developing country improves, the cost of TKR surgery may increase but it will still be a cost-effective strategy to treat OA knee.…”

Section: Discussionmentioning

confidence: 99%

“…The included studies were from different parts of the world with eleven studies from United States (5,18,19,(22)(23)(24)(25)(26)(27)(28)34), four studies from Canada (21,(29)(30)(31), three studies from United Kingdom (8,35,36) and two each from Finland (17,20) and Australia (32,33). One study each was conducted in India (7), China (41), Germany (38), Spain (40), Romania (39), France (37) and Denmark (6) (See table 1).…”

Section: Study Characteristics Description Of Included Studiesmentioning

confidence: 99%

“…Sixteen (5)(6)(7)7,8,18,23,24,(27)(28)(29)(32)(33)(34)36,37) out of twenty-nine studies used model to report outcomes like cost-effectiveness or cost-utility of TKR as mentioned in S2 file. Twelve studies did not provide any justification regarding the scope of model whereas Ferket et al (28) used marginal structure models for repeated measures and justified by stating that "outcome values can vary over time and can predict future treatment assignment along with other time-varying confounders".…”

Section: Model Structure and Outcomementioning

confidence: 99%

“…Out of the 23 studies selected for Purchasing Power Parity analysis, eight studies were from USA (5,(23)(24)(25)(26)(27)(28)34), eight European countries -: from UK (8,35,36), Denmark (6), France (37), Germany (38), Romania (39) and Spain (40), three from Canada (29)(30)(31), two from Australia (32,33) and one from India (7) and one from China (41).…”

Section: Costing Datamentioning

confidence: 99%

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Costs and models used in the economic analysis of Total Knee Replacement (TKR): A Systematic Review

Gandhi¹,

Qadeer²,

Meher³

et al. 2022

Preprint

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Objectives: The major objective of this review was to summarize the evidence on the core modelling specifications and procedures on the cost-effectiveness of TKR compared to non-surgical management. Another objective of this study was to synthesize evidence of TKR cost and compare it across countries using purchasing power parity (PPP). Methodology: The electronic databases used were MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), HTAIn repository and Cost effectiveness Analysis (CEA) registry. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the validity of the methods and transparency in reporting the results of the included studies. The cost of TKR surgery from high income and low- or middle-income countries were extracted and converted to single USD ($) using purchasing power parities (PPP) method. Result: 29 studies were included in this review, out of which eight studies used Markov model, five studies used regression model, one study each reported Marginal structure model and discrete simulation model and decision tree analysis to assess cost-effectiveness of TKR. For PPP, 23 studies were included in the analysis of TKR cost. The average cost of TKR surgery was lowest in developing country like India ($3457) and highest in USA ($19,645). Conclusion: The findings of this review showed that the Markov model was most widely used in the analysis of the cost effectiveness of TKR. Our review also concluded that the cost of TKR was higher in developed countries as compared to developing countries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristics Description Of Included Studiesmentioning

confidence: 99%

Section: Model Structure and Outcomementioning

confidence: 99%

Section: Costing Datamentioning

confidence: 99%

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Costs and models used in the economic analysis of Total Knee Replacement (TKR): A Systematic Review

Gandhi¹,

Qadeer²,

Meher³

et al. 2022

Preprint

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Lifetime Cost-Effectiveness of Structured Education and Exercise Therapy for Knee Osteoarthritis in Australia

Docking,

Ademi,

Barton

et al. 2024

JAMA Netw Open

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ImportanceStructured education and exercise therapy programs have been proposed to reduce reliance on total knee replacement (TKR) surgery and improve health care sustainability. The long-term cost-effectiveness of these programs is unclear.ObjectivesTo estimate the lifetime cost-effectiveness of implementing a national structured education and exercise therapy program for individuals with knee osteoarthritis with the option for future TKR compared with usual care (TKR for all).Design, Setting, and ParticipantsThis economic evaluation used a life table model in combination with a Markov model to compare costs and health outcomes of a national education and exercise therapy program vs usual care in the Australian health care system. Subgroup, deterministic, and probabilistic sensitivity analyses were completed. A hypothetical cohort of adults aged 45 to 84 years who would undergo TKR was created.ExposureStructured education and exercise therapy intervention provided by physiotherapists. The comparator was usual care where all people undergo TKR without accessing the program in the first year.Main Outcomes and MeasuresIncremental net monetary benefit (INMB), with an incremental cost-effectiveness ratio threshold of 28 033 Australian dollars (A$) per quality-adjusted life-year (QALY) gained, was calculated from a health care perspective. Transition probabilities, costs, and utilities were estimated from national registries and a randomized clinical trial.ResultsThe hypothetical cohort included 61 394 individuals (53.9% female; 93.6% aged ≥55 years). Implementation of an education and exercise therapy program resulted in a lifetime cost savings of A$498 307 942 (US $339 922 227), or A$7970 (US $5537) per individual, and resulted in fewer QALYs (0.43 per individual) compared with usual care. At a population level, education and exercise therapy was not cost-effective at the lifetime horizon (INMB, −A$4090 [−US $2841]). Subgroup analysis revealed that the intervention was cost-effective only for the first 9 years and over a lifetime only in individuals with no or mild pain at baseline (INMB, A$11 [US $8]). Results were robust to uncertainty around model inputs.Conclusions and RelevanceIn this economic evaluation of structured education and exercise therapy compared with usual care, the intervention was not cost-effective over the lifetime for all patients but was for the first 9 years and for those with minimal pain. These findings point to opportunities to invest early cost savings in additional care or prevention, including targeted implementation to specific subgroups.

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Forecasting the value of innovation in total knee arthroplasty care: A headroom approach

Otten,

Grimm,

Ramaekers

et al. 2024

J. exp. orthop.

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PurposeTotal knee arthroplasty (TKA) is the standard treatment of end‐stage osteoarthritis. TKA is often used and, therefore, poses a healthcare and societal burden, which is likely to increase further. Headroom analyses evaluate a technology under development by making assumptions about its effectiveness. This article applies a headroom approach to forecast the potential value of innovations that improve TKA‐related care in the Netherlands in terms of cost‐effectiveness and surgeries avoided.MethodsA state‐transition model estimating lifetime direct health effects, healthcare‐ and societal costs and percentage of avoide d surgeries was developed. The model compared care as usual to five hypothetical interventions to calculate the headroom associated with (1) preventing the need for TKAs, (2) preventing the need for all TKA revisions, (3) postponing TKAs without quality‐of‐life loss, (4) preventing periprosthetic joint infections (PJIs) and (5) improving patient satisfaction.ResultsPreventing the need for all TKAs amounted to €43,076 of headroom. Preventing the need for TKA revisions amounted to €2276 (5.8% of surgeries avoided), postponing TKAs by 5 years amounted to €7634 (32.4% of surgeries avoided), preventing PJIs amounted to €1187 (1.4% of surgeries avoided) and improving patient satisfaction amounted to €16,622 (0% of surgeries avoided). The headroom of each hypothetical intervention was highest in younger populations (<50 years of age).ConclusionThere is a headroom for improving TKA‐related care. Innovations to avoid or postpone TKA (i.e., joint‐preserving treatments) as well as those that improve patient satisfaction can be effective in maximizing the value for money and avoiding surgeries. Due to the decreasing average patient age, innovations to reduce revision rates and PJIs will become more valuable as these are most effective in younger patients. It is currently unclear how cost‐effectiveness considerations should be traded off against the prevention of surgery to reduce the increasing burden on the healthcare system.Level of EvidenceLevel III economic evaluation/decision‐analytic model.

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Is It Worth Delaying Total Knee Replacement as Late as Possible? A Cost-Effectiveness Analysis Using a Markov Model in the Indian Setting

Cited by 6 publications

References 48 publications

Costs and models used in the economic analysis of Total Knee Replacement (TKR): A Systematic Review

Costs and models used in the economic analysis of Total Knee Replacement (TKR): A Systematic Review

Lifetime Cost-Effectiveness of Structured Education and Exercise Therapy for Knee Osteoarthritis in Australia

Forecasting the value of innovation in total knee arthroplasty care: A headroom approach

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