Cost-Effectiveness Analysis of Needle Arthroscopy Versus Magnetic Resonance Imaging in the Diagnosis and Treatment of Meniscal Tears of the Knee

Abstract

To determine whether needle arthroscopy (NA) compared with magnetic resonance imaging (MRI) in the diagnosis and treatment of meniscal tears is cost-effective when evaluated over a 2-year period via patient-reported outcomes. The hypothesis is that improved diagnostic accuracy with NA would lead to less costly care and similar outcomes. Methods: A Markov model/decision tree analysis was performed using TreeAge Pro 2017 software. Patients were evaluated for degenerative and traumatic damage to the lateral/medial meniscus. Assumed sensitivities and specificities were derived from the medical literature. The direct costs for care were derived from the 2017 Medicare fee schedule and from private payer reimbursement rates. Costs for care included procedures performed for false-positive findings and for care for false-negative findings. Effectiveness was examined using the global knee injury and osteoarthritis outcome score (KOOS). Patients were evaluated over 2 years for costs and outcomes, including complications. Dominance and incremental cost-effectiveness were evaluated, and 1-to 2-way sensitivity analysis was performed to determine those variables that had the greatest effect. The consolidated economics evaluation and reporting standards checklist for reporting economic evaluations was used. Results: NA was less costly and had similar KOOS versus MRI for both the medial/lateral meniscus with private pay.

Diagnostic and Therapeutic Elbow Arthroscopy Using Small-Bore Needle Arthroscopy

“…The cost effectiveness and diagnostic accuracy of inoffice NA have been previously reported. [1][2][3][4] However, a recent systematic review highlighted the need to establish defined protocols and indications to expand application and widespread clinical use, particularly in the operating room. 10 Despite the exciting prospect of reduced complications due to iatrogenic injury and improved patient outcomes, to our knowledge, there is no English literature on NA use in the elbow to date.…”

“…N eedle arthroscopy (NA) has gained traction as an in-office diagnostic tool. It provides a cost-effective alternative to magnetic resonance imaging [1][2][3][4] and may provide better reliability and diagnostic utility in the setting of certain pathologies, previous surgery, or previous hardware. 2,4,5 As an in-office procedure, it allows direct visualization without the cost and anesthetic risk associated with formal diagnostic arthroscopy.…”

Editorial Commentary: What You See Is What You Get—Is In-Office Needle Arthroscopy Ready for Prime Time?

“…The more recent cost analysis by Zhang et al 1 concurs with a Markov decision tree model published earlier in 2019, but in that study, IONA was also less costly for lateral meniscal tears. 3 Zhang et al rightly point out that IONA is an intra-articular modality only and cannot diagnose concomitant extra-articular soft-tissue damage or important subchondral bone changes in osteochondral lesions. In addition, they point out that IONA is not indicated in the setting of acute knee injury and hemarthrosis.…”

Percutaneous Anterior Cruciate Ligament Repair With Needle Arthroscopy and Biological Augmentation

“…The resolution of needle arthroscopy is approaching that of standard arthroscopy cameras, and multiple studies have shown its safe, effective use as a diagnostic tool in place of magnetic resonance imaging. [2][3][4][5][6][7] Given the quality of imaging, some surgeons are exploring the use of a needle arthroscope as a primary visualization tool in surgery as a replacement for a standard arthroscopy camera. The camera and picture quality, combined with instruments the size of the needle arthroscope, allows for percutaneous surgery, thus minimizing tissue damage and yielding a theoretical reduction in complications.…”