PMID- 24124052
OWN - NLM
STAT- MEDLINE
DCOM- 20140515
LR  - 20220331
IS  - 2151-4658 (Electronic)
IS  - 2151-464X (Linking)
VI  - 66
IP  - 4
DP  - 2014 Apr
TI  - Cost-effectiveness of total knee replacement: a prospective cohort study.
PG  - 592-9
LID - 10.1002/acr.22186 [doi]
AB  - OBJECTIVE: Total knee replacement (TKR) rates have significantly increased in the 
      past decade. While the procedure itself might be costly, the cost-effectiveness 
      and potential offset costs from patient and societal benefits have not been 
      clearly established. The objective of this study was to perform an economic 
      evaluation of TKR in patients with knee osteoarthritis (OA). METHODS: We 
      conducted a 6-month prospective cohort study of 212 patients with knee OA who 
      underwent TKR at a single hospital in Houston, Texas. We included patient-level 
      data from hospital billing databases and the patients' self-reported direct and 
      indirect costs. The clinical outcome measure was pain and function measured by 
      the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 
      questionnaire; we used the minimum clinically important difference (MCID; 
      >/=20-point change) and the WOMAC 20% (WOMAC20), 50% (WOMAC50), and 70% (WOMAC70) 
      relative improvement criteria. Incremental cost-effectiveness ratios were 
      estimated using direct and indirect costs and WOMAC improvement. A societal 
      perspective was used and multiple sensitivity analyses were performed to assess 
      the robustness of the principal analysis. RESULTS: The total incremental cost per 
      TKR was $20,133. The incremental cost-effectiveness ratios (ICERs) for 
      improvement at 6 months were $33,345, $25,255, $35,274, and $56,908 for the MCID, 
      WOMAC20, WOMAC50, and WOMAC70, respectively. Best- and worst-case scenario 
      sensitivity analyses did not have a significant impact on the ICERs. Patient time 
      lost was the most influential variable in the multiway sensitivity analysis. 
      CONCLUSION: TKR is an effective intervention in reducing pain and improving 
      functional status among patients with knee OA and is cost effective at both low 
      and high levels of improvement.
CI  - Copyright (c) 2014 by the American College of Rheumatology.
FAU - Waimann, Christian A
AU  - Waimann CA
AD  - Hospital Dr. Hector Cura, Buenos Aires, Argentina.
FAU - Fernandez-Mazarambroz, Rodrigo J
AU  - Fernandez-Mazarambroz RJ
FAU - Cantor, Scott B
AU  - Cantor SB
FAU - Lopez-Olivo, Maria A
AU  - Lopez-Olivo MA
FAU - Zhang, Hong
AU  - Zhang H
FAU - Landon, Glenn C
AU  - Landon GC
FAU - Siff, Sherwin J
AU  - Siff SJ
FAU - Suarez-Almazor, Maria E
AU  - Suarez-Almazor ME
LA  - eng
GR  - R01 AR048662/AR/NIAMS NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Arthritis Care Res (Hoboken)
JT  - Arthritis care & research
JID - 101518086
SB  - IM
MH  - Aged
MH  - Arthroplasty, Replacement, Knee/*economics
MH  - Cost-Benefit Analysis
MH  - Humans
MH  - Middle Aged
MH  - Osteoarthritis, Knee/*surgery
MH  - Prospective Studies
MH  - Uncertainty
EDAT- 2013/10/15 06:00
MHDA- 2014/05/16 06:00
CRDT- 2013/10/15 06:00
PHST- 2013/02/01 00:00 [received]
PHST- 2013/09/17 00:00 [accepted]
PHST- 2013/10/15 06:00 [entrez]
PHST- 2013/10/15 06:00 [pubmed]
PHST- 2014/05/16 06:00 [medline]
AID - 10.1002/acr.22186 [doi]
PST - ppublish
SO  - Arthritis Care Res (Hoboken). 2014 Apr;66(4):592-9. doi: 10.1002/acr.22186.