Cost-effectiveness of unicompartmental compared to total knee replacement: a population-based study using data from the National Joint Registry for England and Wales

Edward Burn, Alexander Liddle, Thomas Hamilton, Andrew Judge, Hemant Pandit, David Murray, Rafael Pinedo-Villanueva

Research output: Contribution to journalArticle (Academic Journal)peer-review

35 Citations (Scopus)
221 Downloads (Pure)

Abstract

Objectives

To assess the value for money of unicompartmental kneereplacement (UKR) compared to total knee replacement (TKR).

Design

A lifetime Markov model provided the framework for theanalysis.

Setting

Data from the National Joint Registry (NJR) for England andWales primarily informed the analysis.

Participants

Propensity score matched patients in the NJR who received eithera UKR or TKR.

Interventions

UKR is a less invasive alternative to TKR, where only thecompartment affected by osteoarthritis is replaced.

Primaryoutcome measures

Incremental Quality-Adjusted Life Years (QALYs) and healthcaresystem costs.

Results

The 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).

Conclusions

UKR 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.

Original languageEnglish
JournalBMJ Open
Early online date29 Apr 2018
DOIs
Publication statusE-pub ahead of print - 29 Apr 2018

Keywords

  • Knee
  • Osteoarthritis
  • Arthroplasty
  • Unicompartmental knee replacement
  • Total knee replacement

Fingerprint Dive into the research topics of 'Cost-effectiveness of unicompartmental compared to total knee replacement: a population-based study using data from the National Joint Registry for England and Wales'. Together they form a unique fingerprint.

Cite this