Silver-coated megaprostheses may be a cost-effective option for limb salvage surgery
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SAN DIEGO — After wide resection of lower extremity osteosarcoma, use of a silver-coated megaprostheses for reconstruction may be cost-effective at mitigating prosthetic joint infections vs. use of standard implants, according to results.
Dipak B. Ramkumar, MD, and colleagues created a computational cost-effectiveness model by assembling a healthy cohort of patients with localized osteosarcoma that were amenable to limb salvage with endoprosthetic reconstruction.
“We then created an expected value cost-effectiveness model using the payoff cost in inflation adjusted 2020 U.S. dollars, representing the direct medical costs alone and effectiveness in quality-adjusted life expectancy in days,” Ramkumar said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Researchers also ascertained various complications, probabilities, utility values and direct medical costs associated with various health states through a review of the medical literature and used a willingness-to-pay threshold of $100,000.
Ramkumar noted they identified an overall average strategy cost of approximately $45,446, with an associated effectiveness of about 11,824 quality-adjusted life-days after accounting for the potential transition states and results that can happen after undergoing a standard implant replantation for reconstruction.
“The silver-coated implant had a strategy cost of approximately $64,254, with an associated effectiveness of 11,989 quality-adjusted life-days,” Ramkumar said. “So, this then confers an incremental cost-effectiveness ratio of approximately $114.12 per quality-adjusted life-days translated into a year of about roughly $42,000 per quality-adjusted life- year.”
One-way sensitivity analyses looking at the probability of prosthetic joint infection with a standard implant and with a silver-coated implant showed that the standard implant is preferred when the probability of a prosthetic joint infection in a standard implant is less than 8%, according to Ramkumar.
“The moment that infection rate increases beyond 8%, the silver implant is far more cost -effective on the longer scale,” Ramkumar said.
Similarly, he added the silver-coated implant was more cost-effective when the probability of an infection with a silver-coated implant was less than 13%.
“We then simulated a Monte Carlo analysis where we ... repeated the cycle of going through the various phases and transition state of our model for this assembled cohort and we found that with 73.5% confidence, we could effectively say that the silver-coated implants are preferred when we use a willingness-to-pay threshold of $100,000,” Ramkumar said. “That number increases when you lower the willingness-to-pay threshold to $50,000 or even $30,000.”
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Ramkumar DB, et al. Paper 161. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. Aug. 31-Sept. 3, 2021; San Diego.
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