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COST-EFFECTIVENESS AND CLINICAL IMPLICATIONS OF ADVANCED BEARINGS IN TOTAL KNEE ARTHROPLASTY: A LONG-TERM MODELING ANALYSIS

Published online by Cambridge University Press:  28 April 2014

Peter Fennema ,
Thomas J. Heyse  and
Carin A. Uyl-de Groot
Peter Fennema
Affiliation:
Netherlands Institute for Health Sciences, and AMR Advanced Medical Research
Thomas J. Heyse
Affiliation:
Department of Orthopedics and Rheumatology, University Hospital Marburg
Carin A. Uyl-de Groot
Affiliation:
Institute for Medical Technology Assessment, Erasmus University
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Abstract

Background: Polyethylene (PE) wear is a major contributor to implant loosening following total knee arthroplasty (TKA). Advanced bearings are therefore required in TKA to reduce or eliminate wear-related loosening. A recently introduced bearing that combines oxidized zirconium with highly cross-linked PE has been shown to drastically reduce wear in in vitro settings, due to its improved tribological characteristics in both tibial and femoral components. However, there are no data on its cost-effectiveness.

Data and Methods: A Markov model was developed to assess the cost-effectiveness of this low-wear bearing from a German societal perspective. The model population was derived from a registry of 75,000 patients requiring TKA. The model allocated patients to receive either a low-wear or standard articulation, and followed them until death. Revisions and re-revision were included. Input values were derived from registry databases or from published reports in the literature. Threshold analysis and probabilistic sensitivity analysis were conducted to estimate model robustness.

Results: The low-wear articulation prevented 24 (2.4 percent) revisions and 8 (0.8 percent) re-revisions. The total incremental cost-effectiveness ratio (ICER) of the low-wear articulation was EUR 16,474 per quality-adjusted life-year (QALY). For patients aged less than 55 years, an ICER of EUR 653 per QALY was observed. For patients aged over 75 years, this value was EUR 83,300. Threshold and probabilistic sensitivity analysis indicated that these findings were reasonably robust.

Conclusion: Low-wear articulations may be considered cost-effective, although the cost effectiveness is age-dependent, with the cost per QALY being significantly lower for younger people than for older people.

Keywords

Total knee arthroplastyAdvanced bearingsCost-effectivenessMarkov modeling
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 30 , Issue 2 , April 2014 , pp. 218 - 225
Copyright
Copyright © Cambridge University Press 2014 

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