Study: TKR is cost-effective for older, obese patients with knee osteoarthritis
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Total knee replacement increased quality-adjusted life-years and lifetime medical costs in older patients with a BMI of 40 kg/m2 or greater and end-stage knee osteoarthritis, according to published results.
To assess the cost-effectiveness of TKR, researchers analyzed a cohort of patients aged 50 to 65 years and a cohort of patients aged 65 years and older who underwent TKR to treat end-stage knee OA. All patients from both age groups had a BMI of 40 kg/m2 or greater. Outcomes measures included lifetime medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), according to the study.
In the cohort of patients aged 50 to 65 years, researchers found TKR increased QALYs by 0.71 years and lifetime medical costs by $25,200. This resulted in an ICER of $35,200. Similarly, in the cohort of patients aged 65 years and older, researchers found TKR increased QALYs by 0.39 years and lifetime medical costs by $21,100 – an ICER of $54,100, according to the study.
After performing sensitivity analysis to factor in comorbidities such as diabetes and cardiovascular disease, researchers found TKR had a 100% and 90% likelihood of being a cost-effective strategy in patients aged 50 to 65 years and patients aged 65 years and older, respectively.
“This study has important clinical care, policy and research implications. Currently, instead of doing TKR on patients with a BMI of 40 kg/m2 or greater, many surgeons recommend weight-loss interventions, such as exercise or bariatric surgery,” the researchers wrote in the study. “Our analysis suggests that withholding TKR from persons with a BMI of 40 kg/m2 or greater may not be justified from an effectiveness or a cost-effectiveness perspective.”
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