TY - JOUR
T1 - Cost-utility analysis of total knee arthroplasty using 10-year data from a randomised controlled trial
T2 - Implant design influences quality-adjusted life year gain
AU - Chen, B.
AU - Clement, N. D.
AU - MacDonald, D.
AU - Hamilton, D. F.
AU - Gaston, P.
N1 - Funding Information:
B.C. is funded by National Natural Science Foundation of China (Grant No. 81903326) and China Scholarship Council (CSC) as a visiting scholar in Royal Infirmary of Edinburgh. An unrestricted educational grant for the trial was provided to the University of Edinburgh by Stryker UK. These bodies had no role in the design, collection, analysis and interpretation of the data or in the writing of the article and the decision to submit it.
Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/8/3
Y1 - 2023/8/3
N2 - Background: The aim of this study was to perform a cost-utility analysis for total knee arthroplasty (TKA) over a 10-year follow up period. Methods: Two-hundred and twelve patients were randomised to receive either a Kinemax or a Triathlon TKA. Patients were assessed pre-operatively, and at 6 months, and 1, 3, 7 and 10 years postoperatively. The costs of the primary and revision surgery were accounted for. One-year quality-adjusted life year (QALY) gain was used to estimate 10-year gains using the established annual health gain discounts. Results: Forty-eight patients died and eight were revised during the follow up period. Overall QALY gain per patient over the 10-year period was 2.594 and the cost per patient was £6559, which resulted in a cost per QALY of £2761 at 10 years. The Triathlon group had a significantly greater QALY gain compared with the Kinemax (mean difference (MD) 0.53, 95% CI 0.03–1.03, P = 0.02), which resulted in a cost per QALY for the Triathlon group of £2521 compared with £3107 for the Kinemax group at 10 years. The 5% annual discount resulted in a significantly lower QALY gain (MD 0.135, 95% CI 0.201–0.354, P = 0.002), whereas the 3.5% annual discount resulted in non-significant difference in QALY gain compared with the actual gain (MD 0.021, 95% CI −0.084 to 0.077, P = 0.292). Conclusions: TKA was a cost-effective intervention, and the Triathlon was associated with a greater cost effectiveness at 10 years. The 3.5% annual discounts for QALY gain would seem to be the most accurate, with an underestimation being observed with the 5% discount.
AB - Background: The aim of this study was to perform a cost-utility analysis for total knee arthroplasty (TKA) over a 10-year follow up period. Methods: Two-hundred and twelve patients were randomised to receive either a Kinemax or a Triathlon TKA. Patients were assessed pre-operatively, and at 6 months, and 1, 3, 7 and 10 years postoperatively. The costs of the primary and revision surgery were accounted for. One-year quality-adjusted life year (QALY) gain was used to estimate 10-year gains using the established annual health gain discounts. Results: Forty-eight patients died and eight were revised during the follow up period. Overall QALY gain per patient over the 10-year period was 2.594 and the cost per patient was £6559, which resulted in a cost per QALY of £2761 at 10 years. The Triathlon group had a significantly greater QALY gain compared with the Kinemax (mean difference (MD) 0.53, 95% CI 0.03–1.03, P = 0.02), which resulted in a cost per QALY for the Triathlon group of £2521 compared with £3107 for the Kinemax group at 10 years. The 5% annual discount resulted in a significantly lower QALY gain (MD 0.135, 95% CI 0.201–0.354, P = 0.002), whereas the 3.5% annual discount resulted in non-significant difference in QALY gain compared with the actual gain (MD 0.021, 95% CI −0.084 to 0.077, P = 0.292). Conclusions: TKA was a cost-effective intervention, and the Triathlon was associated with a greater cost effectiveness at 10 years. The 3.5% annual discounts for QALY gain would seem to be the most accurate, with an underestimation being observed with the 5% discount.
KW - Cost-utility
KW - Implant
KW - Total knee arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85169935734&partnerID=8YFLogxK
U2 - 10.1016/j.knee.2023.07.002
DO - 10.1016/j.knee.2023.07.002
M3 - Article
C2 - 37542953
AN - SCOPUS:85169935734
SN - 0968-0160
VL - 44
SP - 79
EP - 88
JO - Knee
JF - Knee
ER -