This article is more than 5 years old. Information may no longer be current.
Analysis: TAR for arthritis cost-effective compared with nonoperative management
Click Here to Manage Email Alerts
When investigators considered indirect costs to manage end-stage ankle arthritis were considered, they found total ankle replacement was cost-saving and demonstrated increasing cost-effectiveness in younger patients compared with ankle fusion.
Researchers used direct costs to perform a Markov model analysis from a health-systems perspective and they used direct costs and indirect costs to do the analysis from a societal perspective in this study. They derived the costs from the 2012 Nationwide Inpatient Sample and expressed costs in 2013 U.S. dollars. In the study, the researchers expressed effectiveness as quality-adjusted life years (QALY) and derived model transition probabilities from the available literature.
The study’s principal outcome measure was the incremental cost-effectiveness ratio (ICER).
The results showed there was an ICER of $14,500 per QALY with total ankle replacement (TAR) vs. nonoperative management of ankle arthritis in a direct-cost analysis for the base case. However, when the researchers included indirect costs, they found TAR was more effective and it resulted in $5,900 in lifetime cost savings compared to the lifetime costs after nonoperative management. Ankle replacement also resulted in $800 in lifetime cost savings compared to the lifetime costs following ankle fusion. The results among patients younger than 96 years old showed a preference for surgical management which had a $100,000 per QALY threshold. Similarly, TAR was more cost-effective in younger patients, according to study results.
In all, the results showed TAR was the preferred strategy in 83% of the analyses compared with 12% for ankle fusion and 5% for nonoperative management.
There was model sensitivity to patient age, the direct costs of TAR, the failure rate of TAR and the patients’ probability of developing arthritis following ankle fusion, the researchers noted. – by Casey Tingle
Disclosure: Nwachukwu reports no relevant financial disclosures.
Click Here to Manage Email Alerts