Cost-effectiveness of total knee arthroplasty in the United States
Losina E et al. – Total knee arthroplasty (TKA) appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs confer even greater value per dollar spent than TKAs performed in low-volume centers. Methods- Study determines the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness
- A Markov, state-transition, computer simulation model was developed and was populated with Medicare claims data and cost and outcomes data
- Lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume was estimated
- Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations
Results- Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life yrs (QALYs)
- Lifetime costs rose from $37,100 (no TKA) to $57,900 after TKA, resulting in an incremental cost-effectiveness ratio of $18,300 per QALY
- For high-risk pts, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28,100 per QALY
- At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers
- Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges
- Greatest variations were seen for the quality of life gain after TKA and the cost of TKA
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