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Cost-effectiveness of unicompartmental compared with total knee replacement: A population-based study using data from the National Joint Registry for England and Wales

Cost-effectiveness of unicompartmental compared with total knee replacement: A population-based study using data from the National Joint Registry for England and Wales
Cost-effectiveness of unicompartmental compared with total knee replacement: A population-based study using data from the National Joint Registry for England and Wales

Objectives To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR). Design A lifetime Markov model provided the framework for the analysis. Setting Data from the National Joint Registry (NJR) for England and Wales primarily informed the analysis. Participants Propensity score matched patients in the NJR who received either a UKR or TKR. Interventions UKR is a less invasive alternative to TKR, where only the compartment affected by osteoarthritis is replaced. Primary outcome measures Incremental quality-adjusted life years (QALYs) and healthcare system costs. Results The provision of UKR is expected to lead to a gain in QALYs compared with TKR for all age and gender subgroups (male: <60 years: 0.12, 60-75 years: 0.20, 75+ years: 0.19; female: <60 years: 0.10, 60-75 years: 0.28, 75+ years: 0.44) and a reduction in costs (male: <60: £-1223, 60-75 years: £-1355, 75+ years: £-2005; female: <60 years: £-601, 60-75 years: £-935, 75+ years: £-1102 per patient over the lifetime). UKR is expected to lead to a reduction in QALYs compared with TKR when performed by surgeons with low UKR utilisation but an increase among those with high utilisation (<10%, median 6%: -0.04, ≥10%, median 27%: 0.26). Regardless of surgeon usage, costs associated with UKR are expected to be lower than those of TKR (<10%: £-127, ≥10%: £-758). Conclusions UKR can be expected to generate better health outcomes and lower lifetime costs than TKR. Surgeon usage of UKR does, however, have a significant impact on the cost-effectiveness of the procedure. To achieve the best results, surgeons need to perform a sufficient proportion of knee replacements as UKR. Low usage surgeons may therefore need to broaden their indications for UKR.

knee, osteoarthritis, total knee replacement, unicompartmental knee replacement
2044-6055
Burn, Edward
0277b51a-3aa1-40f2-81fb-96c506587db6
Liddle, Alexander D.
3c68d279-8e28-4714-bf05-503be6b447a2
Hamilton, Thomas W.
d83cacde-820f-4b1b-a069-e6ee97271d4e
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Pandit, Hemant G.
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Murray, David W.
fa0e1764-e600-42bd-937d-6d7e5d623bbc
Pinedo-Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131
Burn, Edward
0277b51a-3aa1-40f2-81fb-96c506587db6
Liddle, Alexander D.
3c68d279-8e28-4714-bf05-503be6b447a2
Hamilton, Thomas W.
d83cacde-820f-4b1b-a069-e6ee97271d4e
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Pandit, Hemant G.
786468fe-77e9-4bc9-996d-74c173e882d6
Murray, David W.
fa0e1764-e600-42bd-937d-6d7e5d623bbc
Pinedo-Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131

Burn, Edward, Liddle, Alexander D., Hamilton, Thomas W., Judge, Andrew, Pandit, Hemant G., Murray, David W. and Pinedo-Villanueva, Rafael (2018) Cost-effectiveness of unicompartmental compared with total knee replacement: A population-based study using data from the National Joint Registry for England and Wales. BMJ Open, 8 (4). (doi:10.1136/bmjopen-2017-020977).

Record type: Article

Abstract

Objectives To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR). Design A lifetime Markov model provided the framework for the analysis. Setting Data from the National Joint Registry (NJR) for England and Wales primarily informed the analysis. Participants Propensity score matched patients in the NJR who received either a UKR or TKR. Interventions UKR is a less invasive alternative to TKR, where only the compartment affected by osteoarthritis is replaced. Primary outcome measures Incremental quality-adjusted life years (QALYs) and healthcare system costs. Results The provision of UKR is expected to lead to a gain in QALYs compared with TKR for all age and gender subgroups (male: <60 years: 0.12, 60-75 years: 0.20, 75+ years: 0.19; female: <60 years: 0.10, 60-75 years: 0.28, 75+ years: 0.44) and a reduction in costs (male: <60: £-1223, 60-75 years: £-1355, 75+ years: £-2005; female: <60 years: £-601, 60-75 years: £-935, 75+ years: £-1102 per patient over the lifetime). UKR is expected to lead to a reduction in QALYs compared with TKR when performed by surgeons with low UKR utilisation but an increase among those with high utilisation (<10%, median 6%: -0.04, ≥10%, median 27%: 0.26). Regardless of surgeon usage, costs associated with UKR are expected to be lower than those of TKR (<10%: £-127, ≥10%: £-758). Conclusions UKR can be expected to generate better health outcomes and lower lifetime costs than TKR. Surgeon usage of UKR does, however, have a significant impact on the cost-effectiveness of the procedure. To achieve the best results, surgeons need to perform a sufficient proportion of knee replacements as UKR. Low usage surgeons may therefore need to broaden their indications for UKR.

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Accepted/In Press date: 15 March 2018
e-pub ahead of print date: 29 April 2018
Published date: April 2018
Keywords: knee, osteoarthritis, total knee replacement, unicompartmental knee replacement

Identifiers

Local EPrints ID: 427004
URI: https://eprints.soton.ac.uk/id/eprint/427004
ISSN: 2044-6055
PURE UUID: 7b32f811-5448-4478-a8c9-4f01660812b1

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Date deposited: 20 Dec 2018 17:30
Last modified: 13 Mar 2019 17:42

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