Cost utility analysis of total knee arthroplasty using 10-year data from a randomised controlled trial: Implant design influences quality - adjusted life year gain

B Chen, N D Clement*, D MacDonald, D F Hamilton, P Gaston

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

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.
Original languageEnglish
Pages (from-to)79-98
JournalThe Knee
Volume44
DOIs
Publication statusPublished - 3 Aug 2023

Keywords / Materials (for Non-textual outputs)

  • Total knee arthroplasty
  • Cost-utility
  • Implant

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