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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2017

01-03-2017 | Knee

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

Authors: William B Smith II, MD, MPH, MBA, Joni Steinberg, PhD, MS, MPH, Stefan Scholtes, PhD, Iain R Mcnamara, MA MRCP FRCS (Tr Orth) MD

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2017

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Abstract

Purpose

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).

Methods

A Markov model was used to simulate theoretical cohorts of patients 40, 50, 60, and 70 years 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.

Results

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.

Conclusions

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.
Appendix
Available only for authorised users
Footnotes
1
QALY, and when comparing multiple interventions, that with the highest NMB is the most cost-effective. An intervention is cost-effective when its NMB is positive, and when comparing multiple interventions, when its NMB is the highest. The NMB maximum cost per QALY society is willing to pay (λ), and when positive, reflects a cost-effective intervention. The output is calculated as the net of an intervention’s cost (Costintervention) and accrued QALYs (QALYintervention) multiplied by society’s willingness to pay per QALY, or λ(Costsociety/QALY).
$${\text{NMB}} = {\text{QALY}}_{{{\text{intervention}}}} \times (\lambda ) - {\text{Cost}}_{{{\text{interverntion}}}}$$
 
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Metadata
Title
Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy
Authors
William B Smith II, MD, MPH, MBA
Joni Steinberg, PhD, MS, MPH
Stefan Scholtes, PhD
Iain R Mcnamara, MA MRCP FRCS (Tr Orth) MD
Publication date
01-03-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3821-3

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