Total knee arthroplasty is cost-effective for many older adults

Total knee arthroplasty (TKA) appears to be cost-effective for older adults with advanced osteoarthritis, according to a report in the June 22 issue of Archives of Internal Medicine.

The report findings suggest that TKA is likely to be cost-effective across all patient risk groups, but appeared more costly and less effective in low-volume centers than in high-volume centers, according to a press release.

Elena Losina, PhD, of Brigham and Women's Hospital and the Boston University School of Public Health, and colleagues developed a computer simulation model and added Medicare claims data and cost and outcomes data from various national and multinational sources to it. Next, they projected the lifetime costs and quality-adjusted life expectancy — or the number of years remaining of good health — for patients at different levels of risk and for receiving TKA at high-volume vs. low-volume facilities.

Undergoing a TKA increased quality-adjusted life expectancy of the Medicare population (average age, 74 years ) from 6.822 to 7.957 quality-adjusted life years (ie, years of life in perfect health). Total costs increased from $37,100 among individuals not receiving TKA to $57,900 per person undergoing the procedure, resulting in a cost-effectiveness ratio of $18,300 per quality-adjusted life year, according to the press release.

The investigators concluded that TKA is a highly cost-effective procedure for the management of end-stage knee osteoarthritis compared with nonsurgical treatments, and is within the range of accepted cost-effectiveness for other musculoskeletal procedures, according to the report.

“This result is robust across a broad range of assumptions regarding both patient risk and hospital volume,” they wrote in their paper. “For patients who choose to undergo total knee arthroplasty, hospital volume plays an important role; regardless of patient risk level, higher-volume centers consistently deliver better outcomes. But the additional survival benefits associated with high-volume centers provide limited cost-effectiveness benefits for high-risk patients deliberating between medium- and high-volume centers.”

Even procedures performed in low-volume centers were more cost-effective than not having total knee arthroplasty, regardless of the patient’s risk of complications, according to the press release.

“Clinicians, patients and policy makers should consider the relative cost-effectiveness of total knee arthroplasty in making decisions about who should undergo total knee arthroplasty, where and when,” the researchers wrote.

Reference:
Losina E, Walensky RP, Kessler CL, et al. Cost-effectiveness of total knee arthroplasty in the United States. Arch Intern Med. 2009;169[12]:1113-1121.