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Knee replacement surgery had minimal effect on quality of life, was not cost-effective
According to a recently published study, knee replacement surgery had a minimal effect on quality of life for patients with osteoarthritis and was not cost-effective.
“Given its limited effectiveness in individuals with less severely affected physical function, performance of total knee replacement in these patients seems to be economically unjustifiable,” Bart Ferket, MD, PhD, assistant professor in the Department of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, said in a press release. “Considerable cost savings could be made by limiting eligibility to patients with more symptomatic knee osteoarthritis.”
Ferket and colleagues assessed data from 4,498 patients with or at high risk for knee osteoarthritis from the Osteoarthritis Initiative (OAI) with no prior knee replacement and who were followed for up to 9 years. The validation cohort used data from 2,907 patients from the Multicenter Osteoarthritis study (MOST) with 2 years of follow-up. The main outcome measures were SF-12 and osteoarthritis-specific quality of life during 96 months, model-based quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness ratio during a lifetime.
In the OAI, total knee replacement (TKR) was associated with quality of life improvements of 1.7 for the SF-12 physical component summary, –10.69 for the WOMAC and 9.16 for the KOOS. The optimal scenario was TKR administered to patients with an SF-12 score of less than 35, given a cost-effectiveness threshold of $200,000 per QALY and cost-savings of $6,974. These findings were consistent with MOST.
In the threshold analysis, TKR would become cost-effective in patients with SF-12 physical component summary scores of no greater than 40 if hospital admission costs fell below $14,000.
“Our results emphasize the need for more research comparing total knee replacement with less expensive, more conservative interventions, particularly in patients with less severe symptoms,” Ferket said in the release. – by Will Offit
Reference:
www.mssm.edu
Disclosures: Ferket reports funding by the American Heart Association. Please see the full study for a list of all other relevant financial disclosures.