Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty: A systematic review and meta-analysis

Abstract

BACKGROUND Over the past years, patient specific instrumentation (PSI) for total knee arthroplasty (TKA) has been implemented and routinely used. No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation (CI) for TKA. AIM To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA. METHODS A literature search was performed in healthcare, economical healthcare, and medical databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library, EconLit). It was conducted in April 2021 and again in January 2022. Relevant literature included randomised controlled trials, retrospective studies, prospective studies, observational studies, and case control studies. All studies were assessed on methodological quality. Relevant outcomes included incremental cost-effectiveness ratio, quality-adjusted life years, total costs, imaging costs, production costs, sterilization associated costs, surgery duration costs and readmission rate costs. All eligible studies were assessed for risk of bias. Meta-analysis was performed for outcomes with sufficient data. RESULTS Thirty-two studies were included into the systematic review. Two were included in the meta-analysis. 3994 PSI TKAs and 13267 CI TKAs were included in the sample size. The methodological quality of the included studies, based on Consensus on Health Economic Criteria-scores and risk of bias, ranged from average to good. PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case. PSI TKA costs more compared to CI TKA when considering imaging and production costs. Considering total costs per patient case, PSI TKA is more expensive in comparison to CI TKA. Meta-analysis comparing total costs for PSI TKA, and CI TKA showed a significant higher cost for PSI TKA. CONCLUSION Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation. Total costs per patient case are increased for PSI TKA when compared to CI TKA.

Flexion contracture can cause component mismatch in the Prophecy® preoperative patient-specific instrumentation for Evolution® medial-pivot knee system

“…Additionally, the surgeon’s CT-based implant plan aligned within one size of the utilized implant 100% of the time for both tibial and femoral components. On a per-case basis, PSI systems may offer cost savings related to implants compared with the overall institutional cost for standard TKA, owing to reduced instrument preparation for only the same size and one size smaller components [ 22 ]. The PSI approach also saves surgical time.…”

“…While PSI is garnering increasing scientific and practical interest, numerous authors have reported improved alignment and component positioning [ 23 , 24 ]. According to Dorling et al [ 22 ], when considering the total cost per patient case, PSI TKA is more expensive than conventional instrumentation TKA. This higher cost is attributed to the imaging and production expenses associated with PSI TKA, despite it being less expensive than conventional instrumentation TKA in terms of mean operating room time, associated costs, and tray sterilization per patient case.…”