Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs

Nwachukwu, Benedict U.; McLawhorn, Alexander S.; Simon, Matthew S.; Hamid, Kamran S.; Demetracopoulos, Constantine A.; Deland, Jonathan T.; Ellis, Scott J.

doi:10.2106/jbjs.n.01215

Cited by 44 publications

(41 citation statements)

References 38 publications

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“…As with surgical reconstruction, there are few studies that have compared conservative management for ankle OA with surgical fusion or replacement for the ankle. Nwachukwu et al 72 performed a cost-effectiveness analysis of operative and non-operative treatments with an emphasis on incremental cost-effectiveness ratio, which considers direct and indirect costs along with QOL years. Their analysis was based on the cost of ankle fusion ($16 754) and ankle replacement ($21 423) from the 2012 Nationwide Inpatient Sample from the USA.…”

Section: Section A: Establishing Las Prevalence and Burdenmentioning

confidence: 99%

“…Their analysis was based on the cost of ankle fusion ($16 754) and ankle replacement ($21 423) from the 2012 Nationwide Inpatient Sample from the USA. Ankle replacement procedures are more expensive than non-operative management, but this technique was optimal in 83% of the analyses when considering direct and indirect costs, along with factors that impact QOL 72. This means that the best option for patients with end-stage OA is a very costly surgery.…”

Section: Section A: Establishing Las Prevalence and Burdenmentioning

confidence: 99%

See 1 more Smart Citation

Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains

et al. 2016

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Lateral ankle sprains (LASs) are the most prevalent musculoskeletal injury in physically active populations. They also have a high prevalence in the general population and pose a substantial healthcare burden. The recurrence rates of LASs are high, leading to a large percentage of patients with LAS developing chronic ankle instability. This chronicity is associated with decreased physical activity levels and quality of life and associates with increasing rates of post-traumatic ankle osteoarthritis, all of which generate financial costs that are larger than many have realised. The literature review that follows expands this paradigm and introduces emerging areas that should be prioritised for continued research, supporting a companion position statement paper that proposes recommendations for using this summary of information, and needs for specific future research.

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Section: Section A: Establishing Las Prevalence and Burdenmentioning

confidence: 99%

Section: Section A: Establishing Las Prevalence and Burdenmentioning

confidence: 99%

Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains

et al. 2016

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“…The authors concluded that total ankle arthroplasty was the most cost-effective strategy, with an incremental cost of $14,500 per QALY compared to nonoperative management. Furthermore, total ankle arthroplasty resulted in a $5900 lifetime savings over nonoperative management and an $800 lifetime savings over ankle fusion [30]. This study elegantly illustrates the point that orthopedic technology with high initial cost may eventually provide greater cost-effectiveness and value in the long term.…”

Section: Total Joint Replacementmentioning

confidence: 68%

“…The cost-effectiveness of total ankle arthroplasty has also been evaluated, comparing it with ankle fusion or nonoperative management for the treatment of end-stage ankle arthritis [30]. The authors concluded that total ankle arthroplasty was the most cost-effective strategy, with an incremental cost of $14,500 per QALY compared to nonoperative management.…”

Section: Total Joint Replacementmentioning

confidence: 99%

Technology assessment and cost-effectiveness in orthopedics: how to measure outcomes and deliver value in a constantly changing healthcare environment

Burnham

Meta

Lizzio

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of review The purpose of this study is to review the basic concepts of healthcare value, patient outcome measurement, and cost-effectiveness analyses as they relate to the introduction of new surgical techniques and technologies in the field of orthopedic surgery. Recent findings An increased focus on financial stewardship in healthcare has resulted in a plethora of cost-effectiveness and patient outcome research. Recent research has made great progress in identifying orthopedic technologies that provide exceptional value and those that do not meet adequate standards for widespread adoption. Summary As the pace of technological innovation advances in lockstep with an increased focus on value, orthopedic surgeons will need to have a working knowledge of value-based healthcare decision-making. Value-based healthcare and costeffectiveness analyses can aid orthopedic surgeons in making ethical and fiscally responsible treatment choices for their patients.

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“…Analysis of the direct and indirect costs associated with either intervention, concluded that total ankle replacement was more cost effective. 28 This observation warrants caution as consideration should also be given to the costs incurred in treating ankle replacement failures, using revision prostheses as well as revisions complicated by infection necessitating amputation. The data are limited and subject to interpretation.…”

Section: Operative Managementmentioning

confidence: 99%

Osteoarthritis of the ankle

Ieong¹,

Keith²,

Robinson³

2020

Orthopaedics and Trauma

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Ankle arthritis is a debilitating condition. Primary ankle joint osteoarthritis is much rarer than hip or knee arthritis. The majority of cases are post-traumatic secondary to previous articular trauma or ligamentous instability. Treatment methods available are guided by disease severity and the patient's functional demands. Weight loss, activity modification, the wearing of an ankle brace or high-topped lace-up boots and orthoses should be the first line of treatment. Joint-sparing procedures such as arthroscopic debridement, supramalleolar osteotomy and distraction arthroplasty have been trialled with low levels of supporting evidence. The demand for joint preservation has led to the development of total ankle allografting procedures, but these have fallen out of favour. Despite advancements, the gold standard for end-stage arthritis remains arthrodesis, although evidence for total ankle arthroplasty in certain groups of patients is increasing. The current third-generation implants have improved survivorship although their results remain inferior to arthroplasty of the hip and knee. There is currently a UK randomized control trial of ankle replacement versus arthrodesis under way as well as several national joint registries, which will hopefully better define those patients who will gain most benefit from replacement as opposed to fusion.

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Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs

Abstract: Economic and decision analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 44 publications

References 38 publications

Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains

Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains

Technology assessment and cost-effectiveness in orthopedics: how to measure outcomes and deliver value in a constantly changing healthcare environment

Osteoarthritis of the ankle

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