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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2019

Open Access 01-06-2019 | Osteoarthrosis | KNEE

The cost-effectiveness of osteochondral allograft transplantation in the knee

Authors: Hema Mistry, Andrew Metcalfe, Nick Smith, Emma Loveman, Jill Colquitt, Pamela Royle, Norman Waugh

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2019

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Abstract

Purpose

Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. They are used to repair combined defects of articular cartilage and bone. Such defects often occur in people far too young to have knee arthroplasty, for whom the main alternative to OCA is conservative symptomatic care, which will not prevent development of osteoarthritis. The aim of this report was to assess the cost-effectiveness of osteochondral allograft transplantation in the knee.

Methods

Systematic review of evidence on clinical effectiveness and economic modelling.

Results

The evidence on osteochondral allograft transplantation comes from observational studies, but often based on good quality prospective registries of all patients having such surgery. Without controlled trials, it was necessary to use historical cohorts to assess the effect of osteochondral grafts. There is good evidence that OCA are clinically effective with a high graft survival rate over 20 years. If an OCA graft fails, there is some evidence that revision with a second OCA is also effective, though less so than primary OCA. Economic modelling showed that osteochondral allograft transplantation was highly cost-effective, with costs per quality adjusted life year much lower than many other treatments considered cost effective.

Conclusions

Osteochondral allograft transplantation appears highly cost-effective though the cost per quality adjusted life year varies according to the widely varying costs of allografts. Based on one small study, revision OCA also appears very cost-effective, but more evidence is needed.

Level of evidence

II.
Appendix
Available only for authorised users
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Metadata
Title
The cost-effectiveness of osteochondral allograft transplantation in the knee
Authors
Hema Mistry
Andrew Metcalfe
Nick Smith
Emma Loveman
Jill Colquitt
Pamela Royle
Norman Waugh
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05392-8

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