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Möller S, Gautschi N, Möller K, Hamilton DF, Giesinger K. Similar QALY gain in primary and revision knee arthroplasty: A cost analysis and Markov model. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38953178 DOI: 10.1002/ksa.12343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/16/2024] [Accepted: 06/16/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE The aim of this study is to investigate the cost-effectiveness of revision total knee arthroplasty compared to primary total knee arthroplasty in terms of cost-per-quality-adjusted life year (QALY). METHODS Data were retrieved for all primary and revision total knee replacement (TKA) procedures performed at a tertiary Swiss hospital between 2006 and 2019. A Markov model was created to evaluate revision risk and we calculated lifetime QALY gain and lifetime procedure costs through individual EuroQol 5 dimension (EQ-5D) scores, hospital costs, national life expectancy tables and standard discounting processes. Cost-per-QALY gain was calculated for primary and revision procedures. RESULTS EQ-5D data were available for 1343 primary and 103 revision procedures. Significant QALY gains were seen following surgery in all cases. Similar, but significantly more QALYs were gained following primary TKA (PTKA) (5.67 ± 3.98) than following revision TKA (RTKA) (4.67 ± 4.20). Cost-per-QALY was €4686 for PTKA and €10,364 for RTKA. The highest average cost-per-QALY was seen in two-stage RTKA (€12,292), followed by one-stage RTKA (€8982). CONCLUSION RTKA results in a similar QALY gain as PTKA. The costs of achieving health gain are two to three times higher in RTKA, but both procedures are highly cost-effective. LEVEL OF EVIDENCE Economic level II.
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Affiliation(s)
- Soeren Möller
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Nora Gautschi
- Institute of Accounting, Control and Auditing, University of St. Gallen, St. Gallen, Switzerland
| | - Klaus Möller
- Institute of Accounting, Control and Auditing, University of St. Gallen, St. Gallen, Switzerland
| | - David F Hamilton
- Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| | - Karlmeinrad Giesinger
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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de la Plaza Llamas R, Ortega Azor L, Hernández Yuste M, Gorini L, Latorre-Fragua RA, Díaz Candelas DA, Al Shwely Abduljabar F, Gemio del Rey IA. Quality-adjusted life years and surgical waiting list: Systematic review of the literature. World J Gastrointest Surg 2024; 16:1155-1164. [PMID: 38690041 PMCID: PMC11056653 DOI: 10.4240/wjgs.v16.i4.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/26/2024] [Accepted: 02/25/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND The quality-adjusted life year (QALY) is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures. Surgical waiting lists (SWLs) represent a pressing problem in public healthcare. The QALY measure has rarely been used in the context of surgery. It would be interesting to know how many QALYs are lost by patients on SWLs. AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature. METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. An unlimited search was carried out in PubMed, updated on January 19, 2024. Data on the following variables were investigated and analyzed: Specialty, country of study, procedure under study, scale used to measure QALYs, the use of a theoretical or real-life model, objectives of the study and items measured, the economic value assigned to the QALY in the country in question, and the results and conclusions published. RESULTS Forty-eight articles were selected for the study. No data were found regarding QALYs lost on SWLs. The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery, with 15 articles each. The country in which the most studies of QALYs were carried out was the United States (n = 21), followed by the United Kingdom (n = 9) and Canada (n = 7). The most studied procedure was organ transplantation (n = 39), including 15 kidney, 14 liver, 5 heart, 4 lung, and 1 intestinal. Arthroplasty (n = 4), cataract surgery (n = 2), bariatric surgery (n = 1), mosaicplasty (n = 1), and septoplasty (n = 1) completed the surgical interventions included. Thirty-nine of the models used were theoretical (the most frequently applied being the Markov model, n = 34), and nine were real-life. The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions, but in 32 articles the survey was not specified. The willingness-to-pay per QALY gained ranged from $100000 in the United States to €20000 in Spain. CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature. The rate of QALYs lost on SWLs has not been determined. Future research is warranted to address this issue.
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Affiliation(s)
- Roberto de la Plaza Llamas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Lorena Ortega Azor
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Marina Hernández Yuste
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Ludovica Gorini
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| | - Raquel Aránzazu Latorre-Fragua
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | | | - Farah Al Shwely Abduljabar
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Ignacio Antonio Gemio del Rey
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
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Howells M, Harper P, Palmer G, Gartner D. Fractured systems: a literature review of OR/MS methods applied to orthopaedic care settings and treatments. Health Syst (Basingstoke) 2023; 13:151-176. [PMID: 39175500 PMCID: PMC11338206 DOI: 10.1080/20476965.2023.2264348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/20/2023] [Indexed: 08/24/2024] Open
Abstract
Orthopaedic systems are facing an impending wave of increased pressures as a result of global ageing populations. This is compounded by the current stresses these services face, as a result of the COVID-19 pandemic, and increasing burden of musculoskeletal conditions. It is vital that measures are taken to alleviate the pressures on these systems, to ensure timely and quality access to care for patients. This literature review presents a taxonomic classification of the applications of Operational Research and Management Science (OR/MS) methodologies to orthopaedic care settings and treatments, covering the general, medical, and methodological context of each paper. Our structured search identified 492 relevant publications that have been included in our analysis. The results found a literature largely dominated by cost analysis applications, typically utilising Markov models or decision trees. Key gaps identified in this review include the lack of holistic modelling of orthopaedic systems and pathways, and limited applications to resource and capacity planning. The implications of our review are that researchers, healthcare professionals and managers can develop a research agenda to address these gaps, and enhance decision support in orthopaedics.
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Affiliation(s)
| | - Paul Harper
- School of Mathematics, Cardiff University, Cardiff, UK
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4
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Sauro KM, Smith C, Kersen J, Schalm E, Jaworska N, Roach P, Beesoon S, Brindle ME. The impact of delaying surgery during the COVID-19 pandemic in Alberta: a qualitative study. CMAJ Open 2023; 11:E90-E100. [PMID: 36720492 PMCID: PMC9894654 DOI: 10.9778/cmajo.20210330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic overwhelmed health care systems, leading many jurisdictions to reduce surgeries to create capacity (beds and staff) to care for the surge of patients with COVID-19; little is known about the impact of this on patients whose surgery was delayed. The objective of this study was to understand the patient and family/caregiver perspective of having a surgery delayed during the COVID-19 pandemic. METHODS Using an interpretative descriptive approach, we conducted interviews between Sept. 20 and Oct. 8, 2021. Adult patients who had their surgery delayed or cancelled during the COVID-19 pandemic in Alberta, Canada, and their family/caregivers were eligible to participate. Trained interviewers conducted semistructured interviews, which were iteratively analyzed by 2 independent reviewers using an inductive approach to thematic content analysis. RESULTS We conducted 16 interviews with 15 patients and 1 family member/caregiver, ranging from 27 to 75 years of age, with a variety of surgical procedures delayed. We identified 4 interconnected themes: individual-level impacts on physical and mental health, family and friends, work and quality of life; system-level factors related to health care resources, communication and perceived accountability within the system; unique issues related to COVID-19 (maintaining health and isolation); and uncertainty about health and timing of surgery. INTERPRETATION Although the decision to delay nonurgent surgeries was made to manage the strain on health care systems, our study illustrates the consequences of these decisions, which were diffuse and consequential. The findings of this study highlight the need to develop and adopt strategies to mitigate the burden of waiting for surgery during and after the COVID-19 pandemic.
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Affiliation(s)
- Khara M Sauro
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta.
| | - Christine Smith
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Jaling Kersen
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Emma Schalm
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Natalia Jaworska
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Pamela Roach
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Sanjay Beesoon
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Mary E Brindle
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
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Papadopoulos G, Griffin S, Rathi H, Gupta A, Sharma B, van Bavel D. Cost-effectiveness analysis of arthroscopic injection of a bioadhesive hydrogel implant in conjunction with microfracture for the treatment of focal chondral defects of the knee - an Australian perspective. J Med Econ 2022; 25:712-721. [PMID: 35575263 DOI: 10.1080/13696998.2022.2078574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM JointRep is a bioadhesive hydrogel arthroscopically injected to facilitate cartilage regeneration. The cost-effectiveness of JointRep with microfracture surgery compared to microfracture alone was evaluated from the Australian healthcare system perspective, in patients with symptomatic focal chondral defects (Outerbridge Grade 3 or 4) of the knee who had failed conservative treatment and were indicated for surgery. MATERIALS AND METHODS A de novo Markov model comprising two health states- 'Alive' and 'Dead' was developed. Model transition probability was based on the general population mortality rates. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, a validated patient-reported tool measuring pain, stiffness, and physical function. The utility was derived by mapping WOMAC scores to EQ-5D scores using a published algorithm. Cost inputs were based on published Australian costs from AR-DRGs, Medicare Benefits Schedule, and Prostheses List. Model outcomes included costs, Quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Base-case analysis was conducted for a time horizon of 3 years and a cycle length of 1 year. Cost and health outcomes were discounted at 5% per annum. Sensitivity and scenario analyses were also conducted. RESULTS Total QALYs were estimated to be higher for JointRep with microfracture surgery (2.61) compared to microfracture surgery alone (1.66), an incremental gain of 0.95 QALY. JointRep with microfracture surgery was associated with an incremental cost of $6,022 compared to microfracture surgery alone, thus leading to an ICER of $6,328. Results were substantially robust to varying parameters in the sensitivity analyses conducted, alternative model settings and assumptions in scenario analyses. LIMITATIONS The clinical inputs used in the model were based on data from short duration, non-randomized, post-market clinical trial. CONCLUSIONS JointRep with microfracture surgery is a cost-effective treatment option compared to microfracture alone from the Australian health care system perspective.
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Affiliation(s)
- George Papadopoulos
- Lucid Health Consulting Pty Ltd, Sydney, Australia
- University of NSW, Sydney, Australia
| | | | | | - Amit Gupta
- Skyward Analytics Pvt Ltd, Gurgaon, India
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Bove AM, Hausmann LR, Piva SR, Brach JS, Lewis A, Fitzgerald GK. Race Differences in Post-Acute Physical Therapy Utilization and Patient-Reported Function after Total Knee Arthroplasty. Arthritis Care Res (Hoboken) 2021; 74:79-88. [PMID: 34553507 DOI: 10.1002/acr.24792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This observational cohort study included patients of Black and White race and non-Hispanic ethnicity with end-stage knee osteoarthritis who were scheduled to receive total knee arthroplasty (TKA) surgery. We examined whether there are race differences in (1) use of physical therapy (PT) across all post-acute settings and (2) patient-reported physical function following TKA. METHODS We collected pre- and post-operative physical function data and post-operative rehabilitation data on 104 Black and White individuals undergoing TKA. Regression analyses and independent samples t-tests were used to explore the predictive value of race on post-operative functional outcome and compare PT utilization within each post-acute setting and across all post-acute rehabilitation settings. RESULTS Total PT received was similar between White and Black participants, but there were significant race differences in PT utilization within specific settings. Race did not significantly predict function after TKA, but Black participants had slightly lower self-reported function both before and after surgery than White participants. CONCLUSION This is the first study to examine both PT utilization and functional outcomes in a sample of individuals undergoing TKA, and results indicate differences in where post-operative PT is received between Black and White patients.
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Affiliation(s)
- Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Leslie Rm Hausmann
- University of Pittsburgh, School of Medicine and Core Investigator, VA Pittsburgh Center for Health Equity Research and Promotion, USA
| | - Sara R Piva
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Allen Lewis
- School of Health Professions, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
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Cochetti A, Ghirardelli S, Iannotti F, Giardini P, Risitano S, Indelli PF. Sensor-guided technology helps to reproduce medial pivot kinematics in total knee arthroplasty. J Orthop Surg (Hong Kong) 2021; 28:2309499020966133. [PMID: 33146082 DOI: 10.1177/2309499020966133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
METHODS Two cohorts of 50 patients each were preoperatively matched to receive the same TKA, having a J-curve femoral design with an adapted "medially congruent" polyethylene insert; the second cohort (group B) underwent the intraoperative sensor-check. Intraoperative sensor data were recorded as tibiofemoral load at 10°, 45°, and 90°. We considered stable knees those with a pressure <50 lbs on the medial compartment, <35 lbs on the lateral, and a mediolateral inter-compartmental difference <15 lbs. Clinical outcomes were evaluated according to the Oxford Knee Score (OKS) and Knee Society Score (KSS). RESULTS All patients (group A: no sensor; group B: sensor) were available at 2-year minimum follow-up (FU; min. 24 months, max. 34 months); no preoperative statistical differences existed between groups in the average range of motion (ROM), OKS, KSS, and body mass index. There were no statistical differences at final FU between groups in the average OKS (group A: 41.1; group B: 41.5), in the average KSS (group A: 165.7; group B: 166.3), or in final ROM (group A: 123°; group B: 124°). One patient in each group required a manipulation under anesthesia. In the sensor group, an accessory soft tissue release/bone recut was necessary after sensor testing with trial components in 24% to obtain the desired loads; in the same group, the level of constraint in the final components was increased to posterior-stabilized in 12% because of an inter-compartmental difference >40 lbs. Surgical time was 8 min longer in the sensor group. CONCLUSION The use of this sensing technology did not improve the clinical outcome but supported multiple intraoperative decisions aimed to better reproduce the medial pivot kinematic of the normal knee.
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Affiliation(s)
- Andrea Cochetti
- Department of Orthopaedic Surgery, Stanford University, Stanford, USA
| | | | | | - Piero Giardini
- Department of Orthopaedic Surgery, Stanford University, Stanford, USA
| | | | - Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University, Stanford, USA.,Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, USA
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Is It Worth Delaying Total Knee Replacement as Late as Possible? A Cost-Effectiveness Analysis Using a Markov Model in the Indian Setting. Value Health Reg Issues 2021; 24:173-180. [PMID: 33831792 DOI: 10.1016/j.vhri.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/02/2020] [Accepted: 12/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Total knee replacement (TKR) is often delayed in younger patients in an attempt to prolong the longevity of the prosthesis and avoid the risk of revision. But delaying a TKR might compromise the quality of life of young patients who are otherwise active and healthy. METHODS We built a Markov decision model to study the simulated clinical course of a 50-year-old patient with severe unilateral knee osteoarthritis who could be either treated with conservative therapies or with a TKR at some point in time. An Indian healthcare payer perspective model was used, and lifetime costs (in Indian rupees), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were calculated. RESULTS In the base case scenario, patients who did not receive a TKR had a total lifetime cost of ₹216 709 and accumulated 13.59 QALYS in their lifetime. Those who received a TKR without delay (at age 50) accumulated 16.71 QALYS in their lifetime with an ICER of ₹9789 per QALY. When TKR was delayed, the total QALYs decreased, and ICER increased with each year of delay. But the cumulative risk of revision decreased from 27.4% when TKR was performed at 50 years to 10.0% when TKR was done at 70 years. CONCLUSION Our analysis found that TKR is a cost-effective procedure when the healthcare payer is willing to pay at least ₹9789 ($132) per QALY. The results also suggested that an early TKR is preferred to a delayed TKR despite the higher incidence of revisions.
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Midgley J. Osteoarthritis and obesity; conservative management, multi-morbidity, surgery and the implications of restricted access to knee or hip replacement: a literature review. Int J Orthop Trauma Nurs 2021; 40:100840. [DOI: 10.1016/j.ijotn.2020.100840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 01/03/2023]
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Lan RH, Yu J, Samuel LT, Pappas MA, Brooks PJ, Kamath AF. How Are We Measuring Cost-Effectiveness in Total Joint Arthroplasty Studies? Systematic Review of the Literature. J Arthroplasty 2020; 35:3364-3374. [PMID: 32680755 DOI: 10.1016/j.arth.2020.06.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As volumes of total hip arthroplasty (THA) and total knee arthroplasty (TKA) continue to rise, it is important to understand their economic impact. No systematic review on cost-effectiveness of THA/TKA has been performed since 2016 despite recent changes in the healthcare environment. The purpose of the study is to provide a contemporary analysis of the cost-effectiveness of total joint arthroplasty and the use of quality-adjusted life years (QALYs). METHODS A systematic review was performed from 2005 to 2020. Online databases (OVID Medline, PubMed, Cost-Effectiveness Analysis Registry, Google Scholar, Elton B. Stephens Co) were queried to identify economic analyses that evaluated the cost-effectiveness of THA/TKA. RESULTS In total, 38 studies met the screening criteria. Study designs were primarily Markov models (68%), cohort studies (16%), and randomized trials (8%). Most studies adopted either a societal perspective (45%) or a health system perspective (39%). Analysis revealed that THA/TKA was strongly cost-effective compared to nonsurgical treatment. THA/TKA procedures that were not delayed were more cost-effective than delayed intervention. The majority of studies used QALYs as the primary quality metric (82%); in all these studies there was a significant improvement in QALYs gained. CONCLUSION Given the high economic impact of arthroplasty, ongoing assessment of cost-effectiveness is needed. Twenty-four percent of studies included in this systematic review were published in the last 4 years of this 15-year study period, highlighting the need for continuous assessment of aggregate data. Future studies should incorporate the cost-effectiveness of THA and TKA with respect to the work-value provided by surgeon providers to support health policy and reimbursement.
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Affiliation(s)
- Roy H Lan
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Jessica Yu
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Matthew A Pappas
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH; Center for Value-Based Care Research, Cleveland Clinic Foundation, Cleveland, OH
| | - Peter J Brooks
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Warwick H, O'Donnell J, Mather RC, Jiranek W. Disparity of health services in patients with knee osteoarthritis before total knee arthroplasty. Arthroplast Today 2020; 6:81-87. [PMID: 32211481 PMCID: PMC7083741 DOI: 10.1016/j.artd.2019.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/19/2019] [Accepted: 11/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background Recent evidence describes which interventions are driving insurance payments in the management of osteoarthritis (OA) before total knee arthroplasty (TKA); however, relatively little is known about how these costs are distributed among patients. Methods We reviewed the Humana claims database for patients who underwent primary TKA from 2009 to 2016. Insurance payments for treatment, imaging, and evaluation and management were calculated from OA diagnosis to TKA, the distribution of payments was determined, and a high-payment group was identified by determining the point at which patients began to account for a disproportionate percentage of payments. This group of high-payment patients was compared with remaining patients (low-payment patients) based on demographic factors and nonarthroplasty payments and utilization. Results The top 30% of patients accounted for more than 70% of nonarthroplasty payments. High-payment patients were more likely to be younger, female, and more comorbid. Median time from diagnosis to TKA for high-payment patients was 3 times longer than that for low-payment patients (654 days [320-1191] vs 204 days [68-582], P < .001), and median payment per patient was more than 5 times higher ($1891 [1405-2782] vs $362 [198-613], P < .001). Conclusions Identification of high-payment patients in the management of knee OA may allow for targeted care pathways and cost-reduction strategies in the nonarthroplasty period, although additional studies are necessary to further characterize this population and efficiently recognize appropriate TKA candidates and timing.
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Affiliation(s)
- Hunter Warwick
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan O'Donnell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Richard C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - William Jiranek
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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García-Pérez L, Ramos-García V, Serrano-Aguilar P, Pais-Brito JL, Aciego de Mendoza M, Martín-Fernández J, García-Maroto R, Arenaza JC, Bilbao A. EQ-5D-5L utilities per health states in Spanish population with knee or hip osteoarthritis. Health Qual Life Outcomes 2019; 17:164. [PMID: 31666071 PMCID: PMC6822337 DOI: 10.1186/s12955-019-1230-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The objective of this study was to obtain utilities by means of EQ-5D-5L for different health states in patients with knee osteoarthritis (KOA) or hip osteoarthritis (HOA) in Spain, and to compare these values with those used in foreign studies with the aim of discussing their transferability for their use in economic evaluations conducted in Spain. METHODS Primary study: Observational prospective study of KOA or HOA patients in Spain. Sociodemographic and clinical characteristics were collected to characterize the sample. Utilities were elicited using the EQ-5D-5L questionnaire. ANOVA and bivariable analyses were conducted to identify differences between health states. LITERATURE REVIEW Using the bibliographic databases NSH EED and CEA Registry, we conducted searches of model-based cost utilities analyses of technologies in KOA or HOA patients. Health states and utilities were extracted and compared with values obtained from the Spanish sample. RESULTS Three hundred ninety-seven subjects with KOA and 361 subjects with HOA were included, with average utilities of 0.544 and 0.520, respectively. In both samples, differences were found in utilities according to level of pain, stiffness and physical function (WOMAC) and severity of symptoms (Oxford scales), so that the worst the symptoms, the lower the utilities. The utilities after surgery were higher than before surgery. Due to limitations from our study related to sample size and observational design, it was not possible to estimate utilities for approximately half the health states included in the published models because they were directly related to specific technologies. For almost 100% of health states of the selected studies we obtained very different utilities from those reported in the literature. CONCLUSIONS To our knowledge this is the first article with detailed utilities estimated using the EQ-5D-5L in Spain for KOA and HOA patients. In both populations, utilities are lower for worse health states in terms of level of pain, stiffness and physical function according to WOMAC, and according to the Oxford scales. Most utilities obtained from the Spanish sample are lower than those reported in the international literature. Further studies estimating utilities from local populations are required to avoid the use of foreign sources in economic evaluations.
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Affiliation(s)
- Lidia García-Pérez
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Camino Candelaria No 44, 1a planta. 38109 El Rosario, Santa Cruz de Tenerife, Spain
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria No 44, 1a planta. 38109 El Rosario, Santa Cruz de Tenerife, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Instituto Universitario de Desarrollo Regional (IUDR), University of La Laguna, San Cristóbal de La Laguna, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), San Cristóbal de La Laguna, Spain
| | - Vanesa Ramos-García
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Camino Candelaria No 44, 1a planta. 38109 El Rosario, Santa Cruz de Tenerife, Spain
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria No 44, 1a planta. 38109 El Rosario, Santa Cruz de Tenerife, Spain
| | - Pedro Serrano-Aguilar
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria No 44, 1a planta. 38109 El Rosario, Santa Cruz de Tenerife, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), San Cristóbal de La Laguna, Spain
| | - José Luis Pais-Brito
- Department of Orthopaedics and Traumatology, University Hospital of Canary Islands, Ctra. Ofra S/N La Cuesta, 38320 La Laguna, Tenerife, Spain
- Department of Orthopaedics and Traumatology, University of La Laguna, San Cristóbal de La Laguna, Spain
| | - María Aciego de Mendoza
- Department of Orthopaedics and Traumatology, University Hospital of Canary Islands, Ctra. Ofra S/N La Cuesta, 38320 La Laguna, Tenerife, Spain
| | - Jesús Martín-Fernández
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Multiprofessional Teaching Unit of Primary and Community Care “Oeste”, Health Service, c/ Alonso Cano 8, Móstoles, 28933 Madrid, Madrid Spain
- Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Roberto García-Maroto
- Traumatology and Orthopedic Surgery Service, Hospital Universitario Clínico San Carlos, C/ Profesor Martín Lagos S/N, 28040 Madrid, Spain
| | - Juan Carlos Arenaza
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Traumatology and Orthopedic Surgery Service, Basurto University Hospital (Osakidetza), Avda. Montevideo, 18, 48013 Bilbao, Bizkaia Spain
| | - Amaia Bilbao
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Research Unit, Basurto University Hospital (Osakidetza), Avda. Montevideo, 18, 48013 Bilbao, Bizkaia Spain
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Bachelet VC, Goyenechea M, Carrasco VA. Policy strategies to reduce waiting times for elective surgery: A scoping review and evidence synthesis. Int J Health Plann Manage 2019; 34:e995-e1015. [PMID: 30793372 DOI: 10.1002/hpm.2751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The purpose of this evidence-based review is to identify and describe the interventions that have been implemented to reduce waiting times for major elective surgery. METHODS Scoping review and presentation of the results according to the SUPPORT tools. We searched MEDLINE/PubMed, Embase, Cochrane Library, SciELO, DARE-HTA, and Google Scholar. The inclusion criteria for research design were comprehensive. RESULTS We identified 5200 records. After eliminating duplicates and screening by title and abstract, 171 records remained for full-text assessment, of which 12 were ultimately included for this review because they reported specific interventions and 96 records were included for further reference. The included studies show significant variability regarding elective procedures, population, and type of provider, as well as in the characteristics of the interventions and the settings. All the studies had methodological limitations. We graded the certainty of the evidence as very low. CONCLUSIONS According to the evidence found for this review, interventions most likely should be multidimensional, with prioritization strategies on the waiting lists to incorporate equity criteria, together with quality management improvements of the surgical pathways and the use of operating rooms, as well as improvements in the planning of the surgical schedule.
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Affiliation(s)
- Vivienne C Bachelet
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile.,Medwave Estudios Limitada, Santiago, Chile
| | | | - Víctor A Carrasco
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile.,Medwave Estudios Limitada, Santiago, Chile
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Van den Wyngaert T, Palli SR, Imhoff RJ, Hirschmann MT. Cost-Effectiveness of Bone SPECT/CT in Painful Total Knee Arthroplasty. J Nucl Med 2018; 59:1742-1750. [DOI: 10.2967/jnumed.117.205567] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/15/2018] [Indexed: 12/15/2022] Open
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Schilling C, Petrie D, Dowsey MM, Choong PF, Clarke P. The Impact of Regression to the Mean on Economic Evaluation in Quasi-Experimental Pre-Post Studies: The Example of Total Knee Replacement Using Data from the Osteoarthritis Initiative. HEALTH ECONOMICS 2017; 26:e35-e51. [PMID: 28127856 DOI: 10.1002/hec.3475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/23/2016] [Accepted: 12/02/2016] [Indexed: 06/06/2023]
Abstract
Many treatments are evaluated using quasi-experimental pre-post studies susceptible to regression to the mean (RTM). Ignoring RTM could bias the economic evaluation. We investigated this issue using the contemporary example of total knee replacement (TKR), a common treatment for end-stage osteoarthritis of the knee. Data (n = 4796) were obtained from the Osteoarthritis Initiative database, a longitudinal observational study of osteoarthritis. TKR patients (n = 184) were matched to non-TKR patients, using propensity score matching on the predicted hazard of TKR and exact matching on osteoarthritis severity and health-related quality of life (HrQoL). The economic evaluation using the matched control group was compared to the standard method of using the pre-surgery score as the control. Matched controls were identified for 56% of the primary TKRs. The matched control HrQoL trajectory showed evidence of RTM accounting for a third of the estimated QALY gains from surgery using the pre-surgery HrQoL as the control. Incorporating RTM into the economic evaluation significantly reduced the estimated cost effectiveness of TKR and increased the uncertainty. A generalized ICER bias correction factor was derived to account for RTM in cost-effectiveness analysis. RTM should be considered in economic evaluations based on quasi-experimental pre-post studies. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Chris Schilling
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Michelle M Dowsey
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Peter F Choong
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Philip Clarke
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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Bedard NA, Dowdle SB, Anthony CA, DeMik DE, McHugh MA, Bozic KJ, Callaghan JJ. The AAHKS Clinical Research Award: What Are the Costs of Knee Osteoarthritis in the Year Prior to Total Knee Arthroplasty? J Arthroplasty 2017; 32:S8-S10.e1. [PMID: 28209276 DOI: 10.1016/j.arth.2017.01.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/20/2016] [Accepted: 01/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite American Academy of Orthopaedic Surgeons Clinical Practice Guidelines (CPGs) related to the non-arthroplasty management of osteoarthritis (OA) of the knee, non-recommended treatments remain in common use. We sought to determine the costs associated with non-arthroplasty management of knee OA in the year prior to total knee arthroplasty (TKA) and stratify them by CPG recommendation status. METHODS The Humana database was reviewed from 2007 to 2015 for primary TKA patients. Costs for hyaluronic acid (HA) and corticosteroid injections, physical therapy, braces, wedge insoles, opioids, non-steroidal anti-inflammatories, and tramadol in the year prior to TKA were calculated. Cost was defined as reimbursement paid by the insurance provider. Costs were analyzed relative to the overall non-inpatient costs for knee OA and categorized based on CPG recommendations. RESULTS In total 86,081 primary TKA patients were analyzed and 65.8% had at least one treatment in the year prior to TKA. Treatments analyzed made up 57.6% of the total non-inpatient cost of knee OA in the year prior to TKA. Only 3 of the 8 treatments studied have a strong recommendation for their use (physical therapy, non-steroidal anti-inflammatories, tramadol) and costs for these interventions represented 12.2% of non-inpatient knee OA cost. In contrast, 29.3% of the costs are due to HA injections alone, which are not supported by CPGs. CONCLUSION In the year prior to TKA, over half of the non-inpatient costs associated with knee OA are from injections, therapy, prosthetics, and prescriptions. Approximately 30% of this is due to HA injections alone. If only interventions recommend by the CPG are utilized then costs associated with knee OA could be decreased by 45%.
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Affiliation(s)
- Nicholas A Bedard
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Spencer B Dowdle
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christopher A Anthony
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - David E DeMik
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michael A McHugh
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kevin J Bozic
- Department of Surgery & Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
| | - John J Callaghan
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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18
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Kamaruzaman H, Kinghorn P, Oppong R. Cost-effectiveness of surgical interventions for the management of osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord 2017; 18:183. [PMID: 28486957 PMCID: PMC5424321 DOI: 10.1186/s12891-017-1540-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 04/28/2017] [Indexed: 01/07/2023] Open
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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Affiliation(s)
- Hanin Kamaruzaman
- Malaysian Health Technology Assessment Section, Ministry of Health, Putrajaya, Malaysia
| | - Philip Kinghorn
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Carter Clement R, Bhat SB, Clement ME, Krieg JC. Medicare reimbursement and orthopedic surgery: past, present, and future. Curr Rev Musculoskelet Med 2017; 10:224-232. [PMID: 28337732 DOI: 10.1007/s12178-017-9406-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW This paper reviews the history and structure of Medicare reimbursement with a focus on aspects relevant to the field of orthopedic surgery. Namely, this includes Parts A and B, with particular attention paid to the origins of Diagnosis Related Groups (DRG) and the physician fee schedule, respectively. We then review newer policies affecting orthopedic surgeons. RECENT FINDINGS Recent Medicare reforms relevant to our field include readmission penalties, the evolution of bundled payments including the mandatory Comprehensive Care for Joint Replacement (CJR) and Surgical Hip and Femur Fracture Treatment (SHFFT) programs, and the new mandatory Merit-based Incentive Payment System (MIPS) pay-for-performance program. Providers are facing an increasingly complex payment system and are required to assume growing levels of financial risk. Physicians and practices who prepare for these changes will likely fare best and may even benefit.
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Affiliation(s)
- R Carter Clement
- Rothman Institute at Thomas Jefferson University, 925 Chestnut St. Fifth Floor, Philadelphia, PA, 19107, USA
| | - Suneel B Bhat
- Rothman Institute at Thomas Jefferson University, 925 Chestnut St. Fifth Floor, Philadelphia, PA, 19107, USA
| | - Meredith E Clement
- Rothman Institute at Thomas Jefferson University, 925 Chestnut St. Fifth Floor, Philadelphia, PA, 19107, USA
| | - James C Krieg
- Rothman Institute at Thomas Jefferson University, 925 Chestnut St. Fifth Floor, Philadelphia, PA, 19107, USA.
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20
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Delanois RE, Patel NK, Mistry JB, Mont MA. Economic Considerations for Obese Patients Undergoing Total Knee Arthroplasty: Commentary on an article by Eric R. Wagner, MD, et al.: "Effect of Body Mass Index on Reoperation and Complications After Total Knee Arthroplasty". J Bone Joint Surg Am 2016; 98:e113. [PMID: 28002381 DOI: 10.2106/jbjs.16.00907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Cohen JR, Bradley AT, Lieberman JR. Preoperative Interventions and Charges Before Total Knee Arthroplasty. J Arthroplasty 2016; 31:2730-2735.e7. [PMID: 27394074 DOI: 10.1016/j.arth.2016.05.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The cost effectiveness of total knee arthroplasty (TKA) has been well established, but little data exist regarding preoperative interventions and their costs. The purpose of this study was to examine preoperative interventions and their associated charges within the 2-year period before TKA. METHODS A retrospective cohort analysis of patients undergoing TKA between 2007 and 2011 was conducted using the PearlDiver Patient Record Database. Patients' inpatient and outpatient billing records were tracked over the 2-year period before receiving a TKA. RESULTS A total of 35,596 patients from Medicare and 47,064 from United Healthcare underwent TKA from 2009 to 2011. In the 2-year period before TKA, the per patient average charge was $3545.82 for Medicare and $3281.57 for United Healthcare. In the 2-year period before TKA, 21.4% (Medicare) and 23.3% (United Healthcare) of all patients received a magnetic resonance imaging, with between 31.9% (Medicare) and 45.6% (United Healthcare) of these occurring within 3 months of surgery (P < .05). During this same period, 49.4% (Medicare) and 63.2% (United Healthcare) of all patients received an intra-articular injection, with between 29.4% (Medicare) and 44.8% (United Healthcare) of these occurring within 3 months of surgery (P < .05). CONCLUSION Interventions and costs before TKA occur largely within 6 months preoperatively, with a substantial portion occurring within 3 months. These interventions may not be clinically or cost effective for certain patients, such as those with moderate-to-severe osteoarthritis. Foregoing these interventions and opting to perform TKA earlier may reduce costs and prevent unnecessary tests and procedures.
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Affiliation(s)
- Jeremiah R Cohen
- David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Orthopaedic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Alexander T Bradley
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
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Feeley BT, Liu S, Garner AM, Zhang AL, Pietzsch JB. The cost-effectiveness of meniscal repair versus partial meniscectomy: A model-based projection for the United States. Knee 2016; 23:674-80. [PMID: 27157145 DOI: 10.1016/j.knee.2016.03.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/24/2016] [Accepted: 03/26/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Meniscal tears are the most common knee condition requiring surgery, and represent a substantial disease burden with clinical and cost implications. The success rates partial meniscectomy and meniscal repair have been studied, but limited information is available investigating their long-term costs and effects. Our objective was to assess the long-term cost-effectiveness of meniscal repair compared to meniscectomy. METHODS We constructed a decision-analytic Markov disease progression model, using strategy-specific failure rates and treatment-specific probabilities for the development of osteoarthritis (OA) and subsequent knee replacement (TKR). Failure rates and OA incidence were derived from controlled and uncontrolled studies as well as meta-analyses. Costs were derived from 2014U.S. reimbursement amounts and published literature. RESULTS Meniscal repair was associated with an increased failure rate (RR of 4.37), but meaningful reductions in OA and TKR incidence (29.7% vs. 39.4% and 19.6% vs. 27.9%, respectively) in our model-based analysis. Over the 30-year horizon, meniscal repair was associated with an increase in discounted QALYs to 16.52 (compared to 16.37 QALYs for meniscectomy), at overall discounted savings of $2384, making it the dominant index procedure strategy. Using age-specific per-patient cost and QALYs projected for the 30-year horizon, our computations suggest that payers could save approximately $43 million annually if 10% of current meniscectomies could be performed as meniscal repairs. CONCLUSIONS Our projection suggests that meniscal repair, despite substantially higher failure rates, is associated with improved long-term outcomes and cost savings relative to meniscectomy in the majority of patients, making it the dominant treatment strategy.
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Affiliation(s)
- Brian T Feeley
- University of California, San Francisco, San Francisco, CA, USA.
| | - Shan Liu
- Wing Tech Inc., Menlo, Park, CA, USA; University of Washington, Seattle, WA, USA
| | | | - Alan L Zhang
- University of California, San Francisco, San Francisco, CA, USA
| | - Jan B Pietzsch
- Wing Tech Inc., Menlo, Park, CA, USA; Stanford University, Stanford, CA, USA
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Smith T, Elson L, Anderson C, Leone W. How are we addressing ligament balance in TKA? A literature review of revision etiology and technological advancement. J Clin Orthop Trauma 2016; 7:248-255. [PMID: 27857498 PMCID: PMC5106479 DOI: 10.1016/j.jcot.2016.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 01/16/2023] Open
Abstract
Despite technological advances in operative technique and component materials, the total knee arthroplasty (TKA) revision burden, in the United States, has remained static for the past decade. In light of an anticipated exponential increase in annual surgical volume, it is important to thoroughly understand contemporary challenges associated with technologically driven TKA. This descriptive literature review harvested 69 relevant publications to extrapolate patient trends, benefits, costs, and complications associated with computer-assisted surgery, patient specific instrumentation, and intra-operative sensors. Due to additional charges, a steep learning curve, and questionable cost-effectiveness, widespread use of these systems has been limited. Intra-operative sensors are a relatively recent development, and have been shown to improve both soft-tissue balance and overall functional outcomes at a relatively low price and without disrupting operative workflow. The introduction of new technology into the operating suite should be considered carefully, especially with respect to combined clinically efficacy and cost.
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Affiliation(s)
- Tyler Smith
- Nova Southeastern University, College of Osteopathic Medicine, 3301 College Avenue, Davie, FL 33314, United States
| | - Leah Elson
- OrthoSensor Inc., Department of Clinical Research, 1855 Griffin Road, Dania Beach, FL 33004, United States
| | - Christopher Anderson
- OrthoSensor Inc., Department of Clinical Research, 1855 Griffin Road, Dania Beach, FL 33004, United States,Corresponding author.
| | - William Leone
- Holy Cross Hospital, Leone Center for Orthopedic Care, 1000 NE 56th Street, Fort Lauderdale, FL 33334, United States
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