Knee Replacement Considered a Good Value
MONDAY June 22, 2009 -- Total knee replacement is cost-effective in older adults with advanced osteoarthritis, a new U.S. study shows.
Researchers used a computer simulation model loaded with Medicare claims data and cost/outcomes data from national and international sources to project lifetime costs and quality-adjusted life expectancy (number of years remaining of good health) for a wide variety of patients.
The results showed that, overall, total knee replacement (arthroplasty) increased quality-adjusted life expectancy among Medicare patients (average age 74) from 6.822 to 7.957 years. The total cost for people receiving total knee replacement was $57,900, compared with $37,100 for those who didn't undergo knee replacement. That means the cost-effectiveness ratio of total knee replacement was $18,300 per quality-adjusted life year.
The researchers at Brigham and Women's Hospital in Boston and the Boston University School of Public Health concluded that total knee replacement is a highly cost-effective treatment for management of end-stage knee osteoarthritis compared with non-surgical therapies, and is within the range of accepted cost-effectiveness for other musculoskeletal procedures.
"This result is robust across a broad range of assumptions regarding both patient risk and hospital volume," the study authors wrote. "For patients who choose to undergo total knee arthroplasty, hospital volume plays an important role: regardless of patient risk level, higher-volume centers consistently deliver better outcomes. But the additional survival benefits associated with high-volume centers provide limited cost-effectiveness benefits for high-risk patients deliberating between medium- and high-volume centers."
The researchers concluded: "Clinicians, patients and policy makers should consider the relative cost-effectiveness of total knee arthroplasty in making decisions about who should undergo total knee arthroplasty, where and when."
The study appears in the June 22 issue of the Archives of Internal Medicine.
The Arthritis Foundation has more about total knee replacement.
Posted: June 2009