Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales
<strong>Objectives</strong> To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR). <strong>Design</strong> A lifetime Markov model provided the framework for the analysis. <strong>Setting</strong> D...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
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BMJ Publishing Group
2018
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| _version_ | 1797096001378451456 |
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| author | Burn, E Liddle, AD Hamilton, TW Judge, A Pandit, HG Murray, DW Villanueva, R |
| author_facet | Burn, E Liddle, AD Hamilton, TW Judge, A Pandit, HG Murray, DW Villanueva, R |
| author_sort | Burn, E |
| collection | OXFORD |
| description | <strong>Objectives</strong> To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR). <strong>Design</strong> A lifetime Markov model provided the framework for the analysis. <strong>Setting</strong> Data from the National Joint Registry (NJR) for England and Wales primarily informed the analysis. <strong>Participants</strong> Propensity score matched patients in the NJR who received either a UKR or TKR. <strong>Interventions</strong> UKR is a less invasive alternative to TKR, where only the compartment affected by osteoarthritis is replaced. <strong>Primary outcome measures</strong> Incremental quality-adjusted life years (QALYs) and healthcare system costs. <strong>Results</strong> 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). <strong>Conclusions</strong> 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. |
| first_indexed | 2024-03-07T04:35:53Z |
| format | Journal article |
| id | oxford-uuid:cfe57c24-e9fb-43fa-bab3-df28c802d78f |
| institution | University of Oxford |
| last_indexed | 2024-03-07T04:35:53Z |
| publishDate | 2018 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:cfe57c24-e9fb-43fa-bab3-df28c802d78f2022-03-27T07:46:04ZCost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and WalesJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:cfe57c24-e9fb-43fa-bab3-df28c802d78fSymplectic Elements at OxfordBMJ Publishing Group2018Burn, ELiddle, ADHamilton, TWJudge, APandit, HGMurray, DWVillanueva, R<strong>Objectives</strong> To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR). <strong>Design</strong> A lifetime Markov model provided the framework for the analysis. <strong>Setting</strong> Data from the National Joint Registry (NJR) for England and Wales primarily informed the analysis. <strong>Participants</strong> Propensity score matched patients in the NJR who received either a UKR or TKR. <strong>Interventions</strong> UKR is a less invasive alternative to TKR, where only the compartment affected by osteoarthritis is replaced. <strong>Primary outcome measures</strong> Incremental quality-adjusted life years (QALYs) and healthcare system costs. <strong>Results</strong> 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). <strong>Conclusions</strong> 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. |
| spellingShingle | Burn, E Liddle, AD Hamilton, TW Judge, A Pandit, HG Murray, DW Villanueva, R Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales |
| title | Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales |
| title_full | Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales |
| title_fullStr | Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales |
| title_full_unstemmed | Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales |
| title_short | Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales |
| title_sort | cost effectiveness of unicompartmental compared with total knee replacement a population based study using data from the national joint registry for england and wales |
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