Do modern total knee replacements offer better value for money? A health economic analysis

Abstract

Purpose Cost effectiveness is an increasingly important factor in today's healthcare environment, and selection of arthroplasty implant is not exempt from such concerns. Quality adjusted life years (QALYs) are the typical tool for this type of evaluation. Using this methodology, joint arthroplasty has been shown to be cost effective; however, studies directly comparing differing prostheses are lacking. Methods Data was gathered in a single-centre prospective double-blind randomised controlled trial comparing the outcome of modern and traditional knee implants, using the Short Form 6 dimensional (SF-6D) score and quality adjusted life year (QALY) methodology. Results There was significant improvement in the SF-6D score for both groups at one year (p<0.0001). The calculated overall life expectancy for the study cohort was 15.1 years, resulting in an overall QALY gain of 2.144 (95 % CI 1.752-2.507). The modern implant group demonstrated a small improvement in SF-6D score compared to the traditional design at one year (0.141 versus 0.143, p=0.94). This difference resulted in the modern implant costing £298 less per QALY at one year. Conclusion This study demonstrates that modern implant technology does not influence the cost-effectiveness of TKA using the SF-6D and QALY methodology. This type of analysis however assesses health status, and is not sensitive to joint specific function. Evolutionary design changes in implant technology are thus unlikely to influence QALY analysis following joint replacement, which has important implications for implant procurement.

The Relationship Between Preoperative Oxford Hip and Knee Score and Change in Health-Related Quality of Life After Total Hip and Total Knee Arthroplasty: Can It Help Inform Rationing Decisions?

“…Our results show that the mean improvement in SF-6D in our patients after both THA (0.27) and TKA (0.22) is well above the MID of 0.041. This is higher than that previously reported [21][22][23], mainly due to lower preoperative SF-6D in our cohort. The mean EQ-5D(SF-12) score also improved significantly from 0.383 to 0.775 (a gain of 0.392) after THA and from 0.433 to 0.747 (þ0.314) after TKA.…”

Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis

“…In a study comparing the outcome of modern and traditional knee implants using the Short Form 6 dimensional (SF-6D) score and quality adjusted life year (QALY) methodology, the modern implant was found to cost $497.66 (£298 in November 2013) less per QALY at one year [20]. As technology continues to progress, we can expect TKA to become less expensive and more effective, making surgery a more costeffective and clinically effective approach than it is today.…”

The Effect of Preoperative Rehabilitation Training on the Early Recovery of Joint Function after Artificial Total Knee Arthroplasty and Its Effect Evaluation

“…e experimental group adopted the pre rehabilitation training method [17]: the pre-rehabilitation training method mainly refers to the training materials for residents of rehabilitation medicine and the accelerated rehabilitation and perioperative management of modern joint replacement (1) Ankle pump training: when performing ankle joint activities, try to make the ankle joint reach the maximum angle as much as possible, maintain it for 5 s, and relax for 5 s, 20 times/group, 10 groups/d; (2) quadriceps isometric contraction training: the patient lies flat on the bed, raises the back of the ankle joint, tightens the anterior thigh muscles, keeps the patella fixed, maintains for 5 s, and relaxes for 5 s, 20 times/group, 4-6 groups/d; (3) straight leg raising training: straighten the knee joint as much as possible and lift it 20 cm away from the bed surface, maintain it for 15 s, and then put it back in place, 20 times/ group, with an interval of 5 s each time, 4-6 groups/d; (4) knee joint active flexion and extension training (AROM): the patient takes a sitting position, flexes the knee joint to the maximum angle, maintains it for 5 seconds, then tries their best to straighten the knee joint, maintains it for 5 seconds, and returns to the original position, 20 times/group, 4-6 groups/d; (5) knee joint passive flexion and extension training (PROM): the patient takes a sitting position, presses down the affected leg with the uninvolved leg to increase the flexion angle, maintains it for 5 seconds, and restores the original position, 20 times/group, 4-6 groups/d; (6) hamstring contraction training: the patient takes a standing position, raises the calf backwards to the maximum angle, persists for 20 s, and returns to the original position, 20 times/group, each interval is 5 s, 4-6 groups/d; (7)…”

“…China is the country with the largest elderly population in the world, accounting for one-fifth of the global elderly population, and it is the country with the fastest aging rate [ 3 ]. Although total knee arthroplasty (TKA) is the most important and effective method to relieve pain and improve functional recovery [ 4 ], doctors are worried about the pain and functional recovery of patients after surgery [ 5 – 7 ]. Literature studies indicate that 30% of patients still have varying degrees of pain after TKA surgery [ 8 ], and knee joint function has not been well recovered [ 9 ].…”