Early assessment of the likely cost-effectiveness of a new technology: A Markov model with probabilistic sensitivity analysis of computer-assisted total knee replacement

2006 ◽  
Vol 22 (2) ◽  
pp. 191-202 ◽  
Author(s):  
Hengjin Dong ◽  
Martin Buxton
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Total Knee Replacement ◽  
Markov Model ◽  
Incremental Cost ◽  
Knee Replacement ◽  
Probabilistic Sensitivity Analysis ◽  
Computer Assisted ◽  
Total Knee

Objectives:The objective of this study is to apply a Markov model to compare cost-effectiveness of total knee replacement (TKR) using computer-assisted surgery (CAS) with that of TKR using a conventional manual method in the absence of formal clinical trial evidence.Methods:A structured search was carried out to identify evidence relating to the clinical outcome, cost, and effectiveness of TKR. Nine Markov states were identified based on the progress of the disease after TKR. Effectiveness was expressed by quality-adjusted life years (QALYs). The simulation was carried out initially for 120 cycles of a month each, starting with 1,000 TKRs. A discount rate of 3.5 percent was used for both cost and effectiveness in the incremental cost-effectiveness analysis. Then, a probabilistic sensitivity analysis was carried out using a Monte Carlo approach with 10,000 iterations.Results:Computer-assisted TKR was a long-term cost-effective technology, but the QALYs gained were small. After the first 2 years, the incremental cost per QALY of computer-assisted TKR was dominant because of cheaper and more QALYs. The incremental cost-effectiveness ratio (ICER) was sensitive to the “effect of CAS,” to the CAS extra cost, and to the utility of the state “Normal health after primary TKR,” but it was not sensitive to utilities of other Markov states. Both probabilistic and deterministic analyses produced similar cumulative serious or minor complication rates and complex or simple revision rates. They also produced similar ICERs.Conclusions:Compared with conventional TKR, computer-assisted TKR is a cost-saving technology in the long-term and may offer small additional QALYs. The “effect of CAS” is to reduce revision rates and complications through more accurate and precise alignment, and although the conclusions from the model, even when allowing for a full probabilistic analysis of uncertainty, are clear, the “effect of CAS” on the rate of revisions awaits long-term clinical evidence.

scholarly journals Clinical and cost-effectiveness of physiotherapy interventions following total knee replacement: a systematic review and meta-analysis

2021 ◽  
Author(s):  
F. Fatoye ◽  
G. Yeowell ◽  
J. M. Wright ◽  
T. Gebrye
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Total Knee Replacement ◽  
Physical Function ◽  
Knee Replacement ◽  
Meta Analysis ◽  
Intervention Group ◽  
Total Knee

Abstract Purpose Osteoarthritis is the single most common cause of pain and disability in older adults. This review addresses the question of the clinical effectiveness and cost-effectiveness of physiotherapy interventions following total knee replacement (TKR). Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, CINAHL, AMED, DARE, HTA and NHS EED databases were searched from inception to 02 May 2020. Search terms related to the clinical and cost-effectiveness of physiotherapy interventions were used. Studies meeting the inclusion criteria were identified and key data were extracted. Random effect meta-analysis was conducted for pain, physical function and range of motion (ROM). Results In total, 1467 studies were identified. Of these, 26 studies were included; methodological quality of most studies was adequate. Physiotherapy interventions were more effective than control for function, SMD − 0.166 [95% Confidence Interval (CI) − 0.420 to 0.088.] and ROM, SMD − 0.219 [95% CI − 0.465 to 0.028] for a follow-up of 2 or 3 months. Patients in the intervention group showed improvement in pain at 12–13 weeks, SMD − 0.175 [95% CI − 0.416 to 0.067]. No evidence on the pooled estimate of cost-effectiveness of physiotherapy interventions was found. Conclusions This is the first systematic review and meta-analysis that has examined the clinical and cost-effectiveness of physiotherapy interventions following TKR. The findings of this review suggest that physiotherapy interventions were effective for improving physical function, ROM and pain in a short-term follow-up following TKR. Insufficient evidence exists to establish the benefit of physiotherapy in the long term for patient with TKR. Further study should examine the long-term effectiveness and cost-effectiveness of physiotherapy interventions.

Manipulation under anaesthesia post total knee replacement: Long term follow up

The Knee ◽  
2012 ◽  
Vol 19 (4) ◽  
pp. 329-331 ◽  
Author(s):  
David Yeoh ◽  
Nick Nicolaou ◽  
Richard Goddard ◽  
Henry Willmott ◽  
Kim Miles ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Long Term Follow Up ◽  
Manipulation Under Anaesthesia ◽  
Total Knee

Cost-effectiveness of dual-mobility components in patients with displaced femoral neck fractures

2021 ◽  
Vol 103-B (12) ◽  
pp. 1783-1790
Author(s):  
Spencer Montgomery ◽  
Jonathan Bourget-Murray ◽  
Daniel Z. You ◽  
Leo Nherera ◽  
Amir Khoshbin ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Femoral Neck ◽  
Incremental Cost ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Physiological Age ◽  
Base Case ◽  
Dual Mobility ◽  
Displaced Femoral Neck Fractures

Aims Total hip arthroplasty (THA) with dual-mobility components (DM-THA) has been shown to decrease the risk of dislocation in the setting of a displaced neck of femur fracture compared to conventional single-bearing THA (SB-THA). This study assesses if the clinical benefit of a reduced dislocation rate can justify the incremental cost increase of DM-THA compared to SB-THA. Methods Costs and benefits were established for patients aged 75 to 79 years over a five-year time period in the base case from the Canadian Health Payer’s perspective. One-way and probabilistic sensitivity analysis assessed the robustness of the base case model conclusions. Results DM-THA was found to be cost-effective, with an estimated incremental cost-effectiveness ratio (ICER) of CAD $46,556 (£27,074) per quality-adjusted life year (QALY). Sensitivity analysis revealed DM-THA was not cost-effective across all age groups in the first two years. DM-THA becomes cost-effective for those aged under 80 years at time periods from five to 15 years, but was not cost-effective for those aged 80 years and over at any timepoint. To be cost-effective at ten years in the base case, DM-THA must reduce the risk of dislocation compared to SB-THA by at least 62%. Probabilistic sensitivity analysis showed DM-THA was 58% likely to be cost-effective in the base case. Conclusion Treating patients with a displaced femoral neck fracture using DM-THA components may be cost-effective compared to SB-THA in patients aged under 80 years. However, future research will help determine if the modelled rates of adverse events hold true. Surgeons should continue to use clinical judgement and consider individual patients’ physiological age and risk factors for dislocation. Cite this article: Bone Joint J 2021;103-B(12):1783–1790.

Long-term outcome of total knee replacement in patients with rheumatoid arthritis

2008 ◽  
Vol 75 (2) ◽  
pp. 163-166 ◽  
Author(s):  
Klemmens Trieb ◽  
Maximillian Schmid ◽  
Thomas Stulnig ◽  
Wolfgang Huber ◽  
Axel Wanivenhaus
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Total Knee
Sign in / Sign up

Export Citation Format

Share Document