Arthroscopic meniscectomy for degenerative meniscal tears reduces knee pain but is not cost-effective in a routine health care setting: a multi-center longitudinal observational study using data from the osteoarthritis initiative

Abstract

In day-to-day clinical practice, arthroscopic meniscectomy in subjects with knee osteoarthritis is associated with € 150,754 per QALY gained, which exceeds the generally accepted willingness to pay (WTP) (range € 20,000-€ 80,000).

How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study

“…APM was associated with a cost of €150 754 per QALY gained, which highly exceeds the generally accepted willingness to pay in the Netherlands (ie, between €10 000 and €80 000 per QALY) 4. That study4 has several limitations, as was illustrated previously 25. First, since this model-based economic evaluation did not randomly assign patients to treatment groups, selection bias lures.…”

“…Our data will further assist clinicians and healthcare decision makers in efficiently allocating already scarce healthcare resources23 and will likely contribute to reducing healthcare costs 24. Rongen and colleagues4 reported the results of a model-based economic evaluation in which they compared APM with matched controls. APM was associated with a cost of €150 754 per QALY gained, which highly exceeds the generally accepted willingness to pay in the Netherlands (ie, between €10 000 and €80 000 per QALY) 4.…”

“…Rongen and colleagues4 reported the results of a model-based economic evaluation in which they compared APM with matched controls. APM was associated with a cost of €150 754 per QALY gained, which highly exceeds the generally accepted willingness to pay in the Netherlands (ie, between €10 000 and €80 000 per QALY) 4. That study4 has several limitations, as was illustrated previously 25.…”

“…Therefore, an economic evaluation, comparing conservative treatment with surgery could confirm the findings of prior research and support implementation of changes in clinical care. A recent model-based economic evaluation found that arthroscopic partial meniscectomy (APM) was not cost-effective in patients with or at risk for osteoarthritis compared with a group of matched controls receiving no treatment 4. As no treatment at all is not a common alternative for surgical treatment in clinical practice, this model should be interpreted with caution.…”

Rates of knee arthroplasty within one-year of undergoing arthroscopic partial meniscectomy in England: temporal trends, regional and age-group variation in conversion rates

“…Some previous studies have suggested that APM itself might increase the risk of progression of radiographic osteoarthritis and subsequent arthroplasty in patients with a meniscal tear, but these studies were also limited by potential selection effects. [46][47][48][49][50][51] Even without alteration of the natural history, it is also possible that some patients received APM for appropriate indications with pre-existent osteoarthritis, for example a "locked knee" with a displaced "bucket-handle" meniscal tear, and then later progressed to end-stage osteoarthritis within 2 years. [19,52] Finally, patients might have undergone an otherwise "diagnostic" arthroscopy for decision making regarding suitability for either a partial or total knee arthroplasty, or arthroscopy for other reasons such a removal of intra-articular implants or loose bodies.…”