Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark
Objective To assess the 24-month cost-effectiveness of total knee replacement (TKR) plus non-surgical treatment compared with non-surgical treatment with the option of later TKR if needed.Methods 100 adults with moderate-to-severe knee osteoarthritis found eligible for TKR by an orthopaedic surgeon...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-01-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/1/e033495.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846138825478242304 |
|---|---|
| author | Sten Rasmussen Søren Thorgaard Skou Lars Arendt-Nielsen Rikke Ibsen Jakob Kjellberg Ewa Roos Mogens Laursen Ole Simonsen Arendse T Larsen |
| author_facet | Sten Rasmussen Søren Thorgaard Skou Lars Arendt-Nielsen Rikke Ibsen Jakob Kjellberg Ewa Roos Mogens Laursen Ole Simonsen Arendse T Larsen |
| author_sort | Sten Rasmussen |
| collection | DOAJ |
| description | Objective To assess the 24-month cost-effectiveness of total knee replacement (TKR) plus non-surgical treatment compared with non-surgical treatment with the option of later TKR if needed.Methods 100 adults with moderate-to-severe knee osteoarthritis found eligible for TKR by an orthopaedic surgeon in secondary care were randomised to TKR plus 12 weeks of supervised non-surgical treatment (exercise, education, diet, insoles and pain medication) or to supervised non-surgical treatment alone. Including quality-adjusted life years (QALYs) data from baseline, 3, 6, 12 and 24 months, effectiveness was measured as change at 24 months. Healthcare costs and transfer payments were derived from national registries. Incremental healthcare costs, and incremental cost-effectiveness ratios (ICERs) were calculated. A probabilistic sensitivity analysis was conducted and the probability of cost-effectiveness was estimated at the 22 665 Euros/QALY threshold defined by the National Institute for Health and Care Excellence.Results TKR plus non-surgical treatment was more expensive (mean of 23 076 vs 14 514 Euros) but also more effective than non-surgical treatment (mean 24-month improvement in QALY of 0.195 vs 0.056). While cost-effective in the unadjusted scenario (ICER of 18 497 Euros/QALY), TKR plus non-surgical treatment was not cost-effective compared with non-surgical treatment with the option of later TKR if needed in the adjusted (age, sex and baseline values), base-case scenario (ICER of 32 611 Euros/QALY) with a probability of cost-effectiveness of 23.2%. Including deaths, TKR plus non-surgical treatment was still not cost-effective (ICERs of 46 277 to 64 208 Euros/QALY).Conclusions From a 24-month perspective, TKR plus non-surgical treatment does not appear to be cost-effective compared with non-surgical treatment with the option of later TKR if needed in patients with moderate-to-severe knee osteoarthritis and moderate intensity pain in secondary care in Denmark. Results were sensitive to changes, highlighting the need for further confirmatory research also assessing the long-term cost-effectiveness of TKR.Trial registration number ClinicalTrials.gov (NCT01410409). |
| format | Article |
| id | doaj-art-6e74bb0034bc4eb8b84199a26f56ebfd |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-6e74bb0034bc4eb8b84199a26f56ebfd2024-12-06T22:40:13ZengBMJ Publishing GroupBMJ Open2044-60552020-01-0110110.1136/bmjopen-2019-033495Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in DenmarkSten Rasmussen0Søren Thorgaard Skou1Lars Arendt-Nielsen2Rikke Ibsen3Jakob Kjellberg4Ewa Roos5Mogens Laursen6Ole Simonsen7Arendse T Larsen8Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, DenmarkDepartment of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, DenmarkCenter for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, DenmarkI2minds, Aarhus, DenmarkVIVE - The Danish Center for Social Science Research, Copenhagen, DenmarkResearch Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, DenmarkOrthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark7Aalborg University hospital, Department of Orthopedic Surgery and clinical medicine, Aalborg, DenmarkVIVE - The Danish Center for Social Science Research, Copenhagen, Hovedstaden, DenmarkObjective To assess the 24-month cost-effectiveness of total knee replacement (TKR) plus non-surgical treatment compared with non-surgical treatment with the option of later TKR if needed.Methods 100 adults with moderate-to-severe knee osteoarthritis found eligible for TKR by an orthopaedic surgeon in secondary care were randomised to TKR plus 12 weeks of supervised non-surgical treatment (exercise, education, diet, insoles and pain medication) or to supervised non-surgical treatment alone. Including quality-adjusted life years (QALYs) data from baseline, 3, 6, 12 and 24 months, effectiveness was measured as change at 24 months. Healthcare costs and transfer payments were derived from national registries. Incremental healthcare costs, and incremental cost-effectiveness ratios (ICERs) were calculated. A probabilistic sensitivity analysis was conducted and the probability of cost-effectiveness was estimated at the 22 665 Euros/QALY threshold defined by the National Institute for Health and Care Excellence.Results TKR plus non-surgical treatment was more expensive (mean of 23 076 vs 14 514 Euros) but also more effective than non-surgical treatment (mean 24-month improvement in QALY of 0.195 vs 0.056). While cost-effective in the unadjusted scenario (ICER of 18 497 Euros/QALY), TKR plus non-surgical treatment was not cost-effective compared with non-surgical treatment with the option of later TKR if needed in the adjusted (age, sex and baseline values), base-case scenario (ICER of 32 611 Euros/QALY) with a probability of cost-effectiveness of 23.2%. Including deaths, TKR plus non-surgical treatment was still not cost-effective (ICERs of 46 277 to 64 208 Euros/QALY).Conclusions From a 24-month perspective, TKR plus non-surgical treatment does not appear to be cost-effective compared with non-surgical treatment with the option of later TKR if needed in patients with moderate-to-severe knee osteoarthritis and moderate intensity pain in secondary care in Denmark. Results were sensitive to changes, highlighting the need for further confirmatory research also assessing the long-term cost-effectiveness of TKR.Trial registration number ClinicalTrials.gov (NCT01410409).https://bmjopen.bmj.com/content/10/1/e033495.full |
| spellingShingle | Sten Rasmussen Søren Thorgaard Skou Lars Arendt-Nielsen Rikke Ibsen Jakob Kjellberg Ewa Roos Mogens Laursen Ole Simonsen Arendse T Larsen Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark BMJ Open |
| title | Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark |
| title_full | Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark |
| title_fullStr | Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark |
| title_full_unstemmed | Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark |
| title_short | Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark |
| title_sort | cost effectiveness of total knee replacement in addition to non surgical treatment a 2 year outcome from a randomised trial in secondary care in denmark |
| url | https://bmjopen.bmj.com/content/10/1/e033495.full |
| work_keys_str_mv | AT stenrasmussen costeffectivenessoftotalkneereplacementinadditiontononsurgicaltreatmenta2yearoutcomefromarandomisedtrialinsecondarycareindenmark AT sørenthorgaardskou costeffectivenessoftotalkneereplacementinadditiontononsurgicaltreatmenta2yearoutcomefromarandomisedtrialinsecondarycareindenmark AT larsarendtnielsen costeffectivenessoftotalkneereplacementinadditiontononsurgicaltreatmenta2yearoutcomefromarandomisedtrialinsecondarycareindenmark AT rikkeibsen costeffectivenessoftotalkneereplacementinadditiontononsurgicaltreatmenta2yearoutcomefromarandomisedtrialinsecondarycareindenmark AT jakobkjellberg costeffectivenessoftotalkneereplacementinadditiontononsurgicaltreatmenta2yearoutcomefromarandomisedtrialinsecondarycareindenmark AT ewaroos costeffectivenessoftotalkneereplacementinadditiontononsurgicaltreatmenta2yearoutcomefromarandomisedtrialinsecondarycareindenmark AT mogenslaursen costeffectivenessoftotalkneereplacementinadditiontononsurgicaltreatmenta2yearoutcomefromarandomisedtrialinsecondarycareindenmark AT olesimonsen costeffectivenessoftotalkneereplacementinadditiontononsurgicaltreatmenta2yearoutcomefromarandomisedtrialinsecondarycareindenmark AT arendsetlarsen costeffectivenessoftotalkneereplacementinadditiontononsurgicaltreatmenta2yearoutcomefromarandomisedtrialinsecondarycareindenmark |