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      Cost-effectiveness of surgical interventions for the management of osteoarthritis: a systematic review of the literature

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          Abstract

          Background

          The primary purpose of this study is to assess the existing evidence on the cost-effectiveness of surgical interventions for the management of knee and hip osteoarthritis by systematically reviewing published economic evaluation studies.

          Methods

          A systematic review was conducted for the period 2004 to 2016. Electronic databases were searched to identify both trial and model based economic evaluation studies that evaluated surgical interventions for knee and hip osteoarthritis.

          Results

          A total of 23 studies met the inclusion criteria and an assessment of these studies showed that total knee arthroplasty (TKA), and total hip arthroplasty (THA) showed evidence of cost-effectiveness and improvement in quality of life of the patients when compared to non-operative and non-surgical procedures. On the other hand, even though delaying TKA and THA may lead to some cost savings in the short-run, the results from the study showed that this was not a cost-effective option.

          Conclusions

          TKA and THA are cost-effective and should be recommended for the management of patients with end stage/severe knee and hip OA. However, there needs to be additional studies to assess the cost-effectiveness of other surgical interventions in order for definite conclusions to be reached.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12891-017-1540-2) contains supplementary material, which is available to authorized users.

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          Most cited references35

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          Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data.

          Albert A. Rizzo, Hai Fang, Harry Kotlarz … (2009)
          Osteoarthritis (OA) is a major debilitating disease affecting approximately 27 million persons in the US. Yet, the financial costs to patients and insurers remain poorly understood. The purpose of this study was to quantify by multivariate analyses the relationships between OA and annual health care expenditures borne by patients and insurers. Data from the Medical Expenditure Panel Survey (MEPS) for the years 1996-2005 were used. MEPS is a large, nationally representative US database that includes information on health care expenditures, medical conditions, health insurance status, and sociodemographic characteristics. Individual and nationally aggregated cost estimates are provided. OA was found to contribute substantially to health care expenditures. Among women, OA increased out-of-pocket (OOP) expenditures by $1,379 per annum (2007 dollars) and insurer expenditures by $4,833. Among men, OA increased OOP expenditures by $694 per annum and insurer expenditures by $4,036. Given the high prevalence of OA, the aggregate effects on health care expenditures were very large. OA raised aggregate annual medical care expenditures by $185.5 billion. Of that amount, insurer expenditures were $149.4 billion and OOP expenditures were $36.1 billion. Because of the greater prevalence of OA in women and their more intensive use of health care, total expenditures for this group accounted for $118 billion, or almost two-thirds of the total increase in health care expenditures resulting from OA. The health care cost burden associated with OA is quite large for all groups examined and is disproportionately higher for women. Although insurers bear the brunt of treatment costs for OA, the OOP costs are also substantial.
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            Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume.

            Nicholas L Holt, Daniel Solomon, Stephen E Wright … (2009)
            Total knee arthroplasty (TKA) relieves pain and improves quality of life for persons with advanced knee osteoarthritis. However, to our knowledge, the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness have not been investigated in the United States. We developed a Markov, state-transition, computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. We projected lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume. Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations. Finally, we conducted sensitivity analyses to determine various parameters' influences on cost-effectiveness. Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life years (QALYs). Lifetime costs rose from $37,100 (no TKA) to $57 900 after TKA, resulting in an incremental cost-effectiveness ratio of $18,300 per QALY. For high-risk patients, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28,100 per QALY. At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers. Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges. The greatest variations were seen for the quality of life gain after TKA and the cost of TKA. Total knee arthroplasty appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs performed in a high-volume hospital confer even greater value per dollar spent than TKAs performed in low-volume centers.
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              Review of guidelines for good practice in decision-analytic modelling in health technology assessment

              Z Philips, L Ginnelly, M. Sculpher … (2004)
              Article 0 comments Cited 110 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Raymond Oppong:
                ORCID: http://orcid.org/0000-0002-0815-4616
                +44 121 414 7065 , r.a.oppong@bham.ac.uk
                Journal
                Journal ID (nlm-ta): BMC Musculoskelet Disord
                Journal ID (iso-abbrev): BMC Musculoskelet Disord
                Title: BMC Musculoskeletal Disorders
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2474
                Publication date (Electronic): 10 May 2017
                Publication date PMC-release: 10 May 2017
                Publication date Collection: 2017
                Volume: 18
                Electronic Location Identifier: 183
                Affiliations
                [1 ]ISNI 0000 0001 0690 5255, GRID grid.415759.b, Malaysian Health Technology Assessment Section, , Ministry of Health, ; Putrajaya, Malaysia
                [2 ]ISNI 0000 0004 1936 7486, GRID grid.6572.6, Health Economics Unit, Institute of Applied Health Research, , University of Birmingham, ; Birmingham, UK
                Author information
                http://orcid.org/0000-0002-0815-4616
                Article
                Publisher ID: 1540
                DOI: 10.1186/s12891-017-1540-2
                PMC ID: 5424321
                PubMed ID: 28486957
                SO-VID: b622b22c-ec16-44b6-8695-1fa45f33c90d
                Copyright © © The Author(s). 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 23 June 2016
                Date accepted : 28 April 2017
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Orthopedics
                Keywords: osteoarthritis,cost-effectiveness,costs,review
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: osteoarthritis, cost-effectiveness, costs, review

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