TY - JOUR
T1 - Cost-effectiveness of unicompartmental compared to total knee replacement
T2 - a population-based study using data from the National Joint Registry for England and Wales
AU - Burn, Edward
AU - Liddle, Alexander
AU - Hamilton, Thomas
AU - Judge, Andrew
AU - Pandit, Hemant
AU - Murray, David
AU - Pinedo-Villanueva, Rafael
PY - 2018/4/29
Y1 - 2018/4/29
N2 - ObjectivesTo assess the value for money of unicompartmental kneereplacement (UKR) compared to total knee replacement (TKR).DesignA lifetime Markov model provided the framework for theanalysis. SettingData from the National Joint Registry (NJR) for England andWales primarily informed the analysis. ParticipantsPropensity score matched patients in the NJR who received eithera UKR or TKR.InterventionsUKR is a less invasive alternative to TKR, where only thecompartment affected by osteoarthritis is replaced.Primaryoutcome measuresIncremental Quality-Adjusted Life Years (QALYs) and healthcaresystem costs.ResultsThe provision of UKR is expected to lead to a gain in QALYs compared to TKR for all age andgender subgroups (Male <60: 0.12,60-75: 0.20, 75+: 0.19, Female <60: 0.10, 60-75: 0.28, 75+: 0.44) and a reduction in costs (Male<60: -£1,223, 60-75:-£1,355,75+: -£2,005, Female <60: -£601, 60-75:-£935,75+: -£1,102 per patient over the lifetime). UKR isexpected to lead to a reduction in QALYs compared to TKR when performed bysurgeons with low UKR utilisation, but an increase among those with highutilisation (<10%, median 6%:-0.04, ≥10%, median 27%: 0.26). Regardless of surgeonusage, costs associated with UKR are expected to be lower than those of TKR (<10%: -£127,≥10%: -£758).ConclusionsUKR can be expected to generate better health outcomes andlower lifetime costs than TKR. Surgeon usage of UKR does, however, have asignificant impact on the cost-effectiveness of the procedure. To achieve thebest results, surgeons need to perform a sufficient proportion of kneereplacements as UKR, hence low-usage surgeon may need to broaden theirindications of UKR to achieve this.
AB - ObjectivesTo assess the value for money of unicompartmental kneereplacement (UKR) compared to total knee replacement (TKR).DesignA lifetime Markov model provided the framework for theanalysis. SettingData from the National Joint Registry (NJR) for England andWales primarily informed the analysis. ParticipantsPropensity score matched patients in the NJR who received eithera UKR or TKR.InterventionsUKR is a less invasive alternative to TKR, where only thecompartment affected by osteoarthritis is replaced.Primaryoutcome measuresIncremental Quality-Adjusted Life Years (QALYs) and healthcaresystem costs.ResultsThe provision of UKR is expected to lead to a gain in QALYs compared to TKR for all age andgender subgroups (Male <60: 0.12,60-75: 0.20, 75+: 0.19, Female <60: 0.10, 60-75: 0.28, 75+: 0.44) and a reduction in costs (Male<60: -£1,223, 60-75:-£1,355,75+: -£2,005, Female <60: -£601, 60-75:-£935,75+: -£1,102 per patient over the lifetime). UKR isexpected to lead to a reduction in QALYs compared to TKR when performed bysurgeons with low UKR utilisation, but an increase among those with highutilisation (<10%, median 6%:-0.04, ≥10%, median 27%: 0.26). Regardless of surgeonusage, costs associated with UKR are expected to be lower than those of TKR (<10%: -£127,≥10%: -£758).ConclusionsUKR can be expected to generate better health outcomes andlower lifetime costs than TKR. Surgeon usage of UKR does, however, have asignificant impact on the cost-effectiveness of the procedure. To achieve thebest results, surgeons need to perform a sufficient proportion of kneereplacements as UKR, hence low-usage surgeon may need to broaden theirindications of UKR to achieve this.
KW - Knee
KW - Osteoarthritis
KW - Arthroplasty
KW - Unicompartmental knee replacement
KW - Total knee replacement
U2 - 10.1136/bmjopen-2017-020977
DO - 10.1136/bmjopen-2017-020977
M3 - Article (Academic Journal)
C2 - 29706598
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
ER -