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Total or partial knee replacement? Cost-utility analysis in patients with knee osteoarthritis based on a 2-year observational study

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Abstract

The objective of this study was to evaluate incremental cost-utility of total knee replacement (TKR) versus unicompartmental knee arthroplasty (UKA) in patients with knee osteoarthritis (OA) of the medial compartment. A 2-year non-randomised prospective observational cohort study was conducted in unicompartmental knee osteoarthritis patients scheduled for TKR (n = 431) or UKA (n = 102). Costs were identified using administrative databases and health outcomes were measured using the SF-36 and the Oxford knee score (OKS) 1 week before, 6 months after, and 2 years after surgery. The incremental cost-utility ratio (ICUR) for TKR versus UKA was calculated and its 95% confidence interval estimated using a nonparametric bootstrapping technique. Cost-effectiveness acceptability curves were constructed from different perspectives. On average, from the societal perspective, the ICUR was US $65,245 per quality-adjusted life-year (QALY). In the scenario with costs calculated from the perspective of patients, the ICUR was $60,382/QALY. This value decreased to $4,860/QALY in the scenario with costs calculated from the governmental perspective. However, the 95% confidence interval of ICURs cannot be defined because more than 5% bootstrapped samples fell into the upper left quadrant of the cost-effectiveness plane from all three perspectives. Based on the 2-year data, TKR gained more QALYs at higher costs compared to UKA. A long-term prospective study is necessary to determine cost-effectiveness of TKR and UKA.

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Authors and Affiliations

  1. Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada

    Feng Xie, Jean-Eric Tarride, Daria O’Reilly & Ron Goeree

  2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Feng Xie, Jean-Eric Tarride, Daria O’Reilly & Ron Goeree

  3. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore

    Ngai-Nung Lo

  4. Centre for Health Services Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Hin-Peng Lee

  5. Department of Community, Occupational, and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Hin-Peng Lee

  6. Department of Clinical Epidemiology and Biostatistics, Programs for Assessment of Technology in Health Research Institute, McMaster University, 25 Main Street West, Suite 2000, Hamilton, ON, L8P 1H1, Canada

    Feng Xie

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  1. Feng Xie
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Xie, F., Lo, NN., Tarride, JE. et al. Total or partial knee replacement? Cost-utility analysis in patients with knee osteoarthritis based on a 2-year observational study. Eur J Health Econ 11, 27–34 (2010). https://doi.org/10.1007/s10198-009-0154-5

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  • DOI: https://doi.org/10.1007/s10198-009-0154-5

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