Is Total Ankle Arthroplasty A Cost-effective Alternative to Ankle Fusion?

Abstract

Background Total ankle arthroplasty (TAA) implantation is increasing, as the potential for pain relief and restoration of function and risks are compared with those for ankle fusion. A previous analysis with a simple decision tree suggested TAA was cost-effective compared with ankle fusion. However, reevaluation is warranted with the availability of newer, more costly implants and longer-term patient followup data. Questions/purposes Considering all direct medical costs regardless of the payer, we determined if TAA remains a cost-effective alternative to ankle fusion when updated evidence is considered. Patients and Methods Using a Markov model, we evaluated expected costs and quality-adjusted life years (QALY) for a 60-year-old hypothetical cohort with endstage ankle arthritis treated with either TAA or ankle fusion. Costs were estimated from 2007 diagnosis-related group (DRG) and current procedural terminology (CPT) codes for each procedure. Rates were extracted from the literature. The incremental cost-effectiveness ratio (ICER), a measure of added cost divided by QALY gained for TAA relative to ankle fusion, was estimated. To identify factors affecting the value of TAA, sensitivity analyses were performed on all variables.

Total ankle replacement and contralateral ankle arthrodesis in 16 patients from the Swedish Ankle Registry: Self-reported function and satisfaction

“…Courville et al used a Markov model and concludes that TAR is a cost-effective alternative to ankle fusion [21]. 1 OA 75 135 27 2 23 14 5 2 Pta 65 51 31 1 127 31 2 3 RA 63 134 20 4 31 19 3 4 HChr 64 50 36 2 65 35 1 5 Pta 63 141 30 1 85 26 2 6 OA 57 68...…”

Ankle Arthritis: Which to Choose – Arthrodesis or Arthroplasty

“…Bonnin et al noted 65.2% after 10 years in TAR using the Salto Prosthesis (14). Furthermore, Courville et al concluded in a costeffective analysis of a hypothetical 60 year old cohort that TAR remained cost effective alternative to ankle arthrodesis despite newer costly implants and longer follow-up (15).…”

Current Concepts in the Management of Ankle Osteoarthritis: A Systematic Review

“…Another retrospective study examined the effect of complications after both procedures and found comparable outcomes in terms of pain relief and improved function compared with the preoperative baseline; however, the study again showed a significantly greater rate of complications in the arthroplasty group (86). The economics of arthroplasty versus arthrodesis have also been examined, and arthroplasty has been found to be cost-effective despite more expensive implants and a longer follow-up period (87).…”