The Cost-Effectiveness of Surgical Treatment of Medial Unicompartmental Knee Osteoarthritis in Younger Patients

Object Incremental cost-effectiveness analysis is critical to the efficient allocation of health care resources; however, the incremental cost-effectiveness ratio (ICER) of surgical versus nonsurgical treatment for adult spinal deformity (ASD) has eluded the literature, due in part to inherent empirical difficulties when comparing surgical and nonsurgical patients. Using observed preoperative health-related quality of life (HRQOL) for patients who later underwent surgery, this study builds a statistical model to predict hypothetical quality-adjusted life years (QALYs) without surgical treatment. The analysis compares predicted QALYs to observed postoperative QALYs and forms the resulting ICER. Methods This was a single-center (Baylor Scoliosis Center) retrospective analysis of consecutive patients undergoing primary surgery for ASD. Total costs (expressed in 2010 dollars) incurred by the hospital for each episode of surgical care were collected from administrative data and QALYs were calculated from the 6-dimensional Short-Form Health Survey, each discounted at 3.5% per year. Regression analysis was used to predict hypothetical QALYs without surgery based on preoperative longitudinal data for 124 crossover surgical patients with similar diagnoses, baseline HRQOL, age, and sex compared with the surgical cohort. Results were projected through 10-year follow-up, and the cost-effectiveness acceptability curve (CEAC) was estimated using nonparametric bootstrap methods. Results Three-year follow-up was available for 120 (66%) of 181 eligible patients, who were predominantly female (89%) with average age of 50. With discounting, total costs averaged $125,407, including readmissions, with average QALYs of 1.93 at 3-year follow-up. Average QALYs without surgery were predicted to be 1.6 after 3 years. At 3- and 5-year follow-up, the ICER was $375,000 and $198,000, respectively. Projecting through 10-year follow-up, the ICER was $80,000. The 10-year CEAC revealed a 40% probability that the ICER was $80,000 or less, a 90% probability that the ICER was $90,000 or less, and a 100% probability that the ICER was less than $100,000. Conclusions Based on the WHO's suggested upper threshold for cost-effectiveness (3 times per capita GDP, or $140,000 in 2010 dollars), the analysis reveals that surgical treatment for ASD is cost-effective after a 10-year period based on predicted deterioration in HRQOL without surgery. The ICER well exceeds the WHO threshold at earlier follow-up intervals, highlighting the importance of the durability of surgical treatment in assessing the value of surgical intervention. Due to the study's methodology, the results are dependent on the predicted deterioration in HRQOL without surgery. As such, the results may not extend to patients whose HRQOL would remain steady without surgery. Future research should therefore pursue a direct comparison of QALYs for surgical and nonsurgical patients to better understand the cost-effectiveness of surgery for the average ASD patient.

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Cost-effectiveness of telephone-based weight loss support for patients with knee osteoarthritis: a pragmatic randomised controlled trial

10.1101/284588 ◽

2018 ◽

Author(s):

KM O’Brien ◽

JM van Dongen ◽

A Williams ◽

SJ Kamper ◽

J Wiggers ◽

...

Keyword(s):

Weight Loss ◽

Cost Effectiveness ◽

Knee Osteoarthritis ◽

Usual Care ◽

Weight Management ◽

Healthy Lifestyle ◽

Cost Effective ◽

Disability Weight ◽

The Cost ◽

Disease Specific

AbstractBackgroundTelephone-based support offers a promising option to provide widely accessible and cost-effective weight loss care to the people with knee osteoarthritis who are overweight. While telephone-based interventions targeting weight loss are used routinely in the general populations, the cost-effectiveness of referring patients with knee osteoarthritis to these is unknown. The aim of this study was to assess the cost-effectiveness of referral to a telephone-based weight management and healthy lifestyle service for patients with knee osteoarthritis, who are overweight or obese, compared to usual care.MethodsWe randomised 120 patients with knee osteoarthritis to an intervention or usual care control group in a 1:1 ratio. Participants in the intervention group received a referral to an existing non-disease specific 6-month telephone-based weight management and healthy lifestyle service. The primary outcome of the study was quality-adjusted life years (QALYs). Secondary outcomes included pain intensity, disability, weight, and body mass index (BMI). Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain. The primary cost-effectiveness analysis was performed from the societal perspective.ResultsMean cost differences between groups (intervention minus control) were, $454 (95%CI: −2735 to 4206) for healthcare costs, $-36, (95%CI: −73 to 2) for medication costs, and $-13 (95%CI: −225 to 235) for absenteeism costs. The total mean difference in societal costs was $1022 (95%CI: −2201 to 4771). For all outcomes, the probability of the intervention being cost-effective compared with usual care was less than 0.33 at all willingness-to-pay values.ConclusionFrom a societal perspective, telephone-based weight loss support, provided using an existing non-disease specific 6-month weight management and healthy lifestyle service was not cost-effective in comparison with usual care for overweight and obese patients with knee osteoarthritis for QALYs, pain intensity, disability, weight, and BMI.

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Simultaneous bilateral unicompartmental knee arthroplasty surgery has benefits in low complication rate and cost-effectiveness: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000382 ◽

2020 ◽

Vol 5 (4) ◽

pp. 218-223

Author(s):

Nicolas Pujol ◽

Yoshiki Okazaki ◽

Takayuki Furumatsu

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Cost Savings ◽

Level Of Evidence ◽

Patient Profile ◽

One Stage ◽

Unicompartmental Knee

ImportanceBilateral knee osteoarthritis is frequent and the best choice of treatment remains questionable, especially when the surgeon has to consider simultaneous or staged bilateral unicompartmental knee arthroplasty (UKA).ObjectiveThe purpose of this systematic review was to conduct a systematic review assessing the clinical outcomes associated with simultaneous bilateral and staged bilateral UKA.Evidence reviewA literature search was conducted in June 2019 in Medline, PubMed and Embase. A full-text review of eligible studies was conducted by two investigators.FindingsA total of 10 retrospective studies were identified. These studies described the results of simultaneous bilateral UKA compared either to staged bilateral UKA or unilateral UKA. Results showed that the prevalence of mortality at a minimum of 30 days postoperatively, deep vein thrombosis, the rate of blood transfusion and reintervention were not higher in patients undergoing a one-stage bilateral UKA. The cost-effectiveness is in favour of doing a one-stage procedure due to the shortness of total hospital stay.Conclusions and relevanceOne-stage simultaneous bilateral UKA can be performed with preventing the postoperative complication, and result in cost savings for patients with symptomatic medial bilateral unicompartmental knee osteoarthritis. Further comparative studies are necessary to determine the best patient profile for such a surgery, and the technical considerations during surgery (consecutive surgery or simultaneous surgery with two operative teams).Level of evidenceIV.

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Clinical and cost-effectiveness conducted simultaneous operations in women with combined surgical and extragenital gynecological pathology

HEALTH OF WOMAN ◽

10.15574/hw.2017.118.93 ◽

2017 ◽

pp. 93-97

Author(s):

V.L. Dronova ◽

◽

O.I. Dronov ◽

O.V. Lutsenko ◽

R.S. Teslyuk ◽

...

Keyword(s):

Cost Effectiveness ◽

Surgical Treatment ◽

Economic Efficiency ◽

Surgical Pathology ◽

Simultaneous Operation ◽

Significant Prolongation ◽

Medical Institutions ◽

Simultaneous Operations ◽

Planning Department ◽

The Cost

The article presents data of economic efficiency of simultaneous operations in women with combined surgical and extra-gynecological pathology, allowing rational use of material and technical base of medical institutions, and conducted simultaneous operations leading to significant financial savings, both in hospital and at the outpatient . The objective: to determine the clinical and economic effectiveness of simultaneous operations in women with combined extra-gynecological and surgical pathology operated in the department of operative gynecology control IPOG (Institute of Pediatrics, Obstetrics and Gynecology) NAMS of Ukraine for 2015 and modified using special formulas. Patients and methods. The study laid out a retrospective analysis of the immediate results of surgical treatment of 40 patients department of operative gynecology control IPOG NAMS Ukraine. The calculation was performed on the following parameters: value of preoperative examination, providing perioperative medical support, operational support, anesthesia and postoperative laboratory monitoring. Results. Analysis of the research shows that simultaneous operation in two to three times shortens the patient’s stay in hospital and the duration of temporary disability, three times increases the cost-effectiveness of treatment and improve the quality of life of patients. To increase the profitability of the surgical departments recommended minimum break-even calculate the intensity of operations, which is the base for operational planning department. Conclusion. Conducting simultaneous operations in women with combined extra-gynecological and surgical pathology can effectively reduce the cost of surgical treatment of patients with no significant prolongation of the transaction period and the postoperative period. Simultaneous operations may be performed in specialized hospitals with modern equipment available and a multidisciplinary team of surgeons in identifying women with two or more diseases requiring surgical correction. Key words: simultaneous operation, economic efficiency, combined surgical and gynecological extragenital pathology in women.

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The Cost-Effectiveness of Acetaminophen, NSAIDs, and Selective COX-2 Inhibitors in the Treatment of Symptomatic Knee Osteoarthritis

Value in Health ◽

10.1046/j.1524-4733.2003.00215.x ◽

2003 ◽

Vol 6 (2) ◽

pp. 144-157 ◽

Cited By ~ 38

Author(s):

Celia C. Kamath ◽

Hilal Maradit Kremers ◽

David J. Vanness ◽

W. Michael O'Fallon ◽

Rosa L. Cabanela ◽

...

Keyword(s):

Cost Effectiveness ◽

Knee Osteoarthritis ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee ◽

Cox 2 ◽

The Cost ◽

Cox 2 Inhibitors

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Imaging versus Intervention in Managing Small Unruptured Intracranial Aneurysms: A Cost-Effectiveness Analysis

Cerebrovascular Diseases ◽

10.1159/000519538 ◽

2021 ◽

pp. 1-11

Author(s):

Clark A. Veet ◽

Stephen Capone ◽

David Panczykowski ◽

Natasha Parekh ◽

Kenneth J. Smith ◽

...

Keyword(s):

Cost Effectiveness ◽

Surgical Treatment ◽

Active Surveillance ◽

Intracranial Aneurysms ◽

Surgical Complication ◽

Cost Effective ◽

Anterior Circulation ◽

Complication Risk ◽

Immediate Surgery ◽

The Cost

Objective: Current guidelines recommend active surveillance with serial magnetic resonance angiography (MRA) for management of small, asymptomatic unruptured anterior circulation aneurysms (UIAs). We sought to determine the cost-effectiveness of active surveillance compared to immediate surgery. Methods: We developed a Markov cost-effectiveness model simulating patients with small (<7 mm) UIAs managed by active surveillance via MRA, immediate surgery, or watchful waiting. Inputs for the model were abstracted from the literature and used to construct a comprehensive model following persons from diagnosis to death. Outcomes were quality-adjusted life-years (QALYs), lifetime medical costs (2015 USD), and incremental cost-effectiveness ratios (ICERs). Cost-effectiveness, deterministic, and probabilistic sensitivity analyses were performed. Results: Immediate surgical treatment was the most cost-effective management strategy for small UIAs with ICER of USD 45,772 relative to active surveillance. Sensitivity analysis demonstrated immediate surgery was the preferred strategy, if rupture rate was >0.1%/year and if the diagnosis age was <70 years, while active surveillance was preferred if surgical complication risk was >11%. Probabilistic sensitivity analysis demonstrated that at a willingness-to-pay of USD 100,000/QALY, immediate surgical treatment was the most cost-effective strategy in 64% of iterations. Conclusion: Immediate surgical treatment is a cost-effective strategy for initial management of small UIAs in patients <70 years of age. While more costly than MRA, surgical treatment increased QALY. The cost-effectiveness of immediate surgery is highly sensitive to diagnosis age, rupture rate, and surgical complication risk. Though there are a wide range of rupture rates and complications associated with treatment, this analysis supports the treatment of small, unruptured anterior circulation intracranial aneurysms in patients <70 years of age.

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The Cost-Effectiveness of Nonsurgical Versus Surgical Treatment for Carpal Tunnel Syndrome: Invited Commentary

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2009.06.009 ◽

2009 ◽

Vol 34 (7) ◽

pp. 1201-1203 ◽

Cited By ~ 1

Author(s):

Steven C. Haase ◽

Kevin C. Chung

Keyword(s):

Cost Effectiveness ◽

Surgical Treatment ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Tunnel Syndrome ◽

The Cost

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Cost-Effectiveness of Percutaneous Automated Lumbar Nucleotomy

Interventional Neuroradiology ◽

10.1177/159101999900500106 ◽

1999 ◽

Vol 5 (1) ◽

pp. 35-42 ◽

Cited By ~ 2

Author(s):

R. Dullerud ◽

H. Lie ◽

B. Magnæs

Keyword(s):

Cost Effectiveness ◽

Surgical Treatment ◽

Lumbar Disc ◽

Invasive Procedure ◽

Cost Effective ◽

Clinical Results ◽

Complication Rates ◽

Success Rates ◽

One Year ◽

The Cost

This study was conducted in order to evaluate the cost-effectiveness of percutaneous automated lumbar nucleotomy in comparison with traditional macro-procedure discectomy in the treatment of herniated discs. Sixty-eight patients undergoing surgical procedures and 90 treated with nucleotomy were consecutively included. Both cohorts were assessed pre-operatively and at regular intervals for one year or more after treatment by independent observers, using a clinical overall scoring system (COS) with 0 being the best attainable result and 1000 the poorest conceivable status of the patients. There were better clinical results after surgery with 78% successes after one year compared to 62% after nucleotomy. By including subsequent operations and re-operations after failure to respond to the primary treatment, the success rates rose to 79% and 77%, respectively. The cost of surgical treatment was calculated to USD 6.119 per patient and the cost of a nucleotomy procedure was USD 1.252. Owing to an almost five times higher price of surgery than nucleotomy, the latter turned out to be 2.7 to 3.9 times more cost-effective, depending on whether secondary treatment was included or not. Due to the minimal difference in final outcome between the groups, however, the marginal cost per extra success in patients primarily treated with surgery was as high as USD 205.850. The study concludes that nucleotomy, as a mini-invasive procedure with low complication rates and the potential of a quick recovery, is more cost-effective than traditional surgical treatment for lumbar disc herniation.

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