• Angela T Chen, Corin I Bronsther, Elizabeth E Stanley, A David Paltiel, James K Sullivan, Jamie E Collins, Tuhina Neogi, Jeffrey N Katz, and Elena Losina.
• The Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Brigham and Women's Hospital, Boston, Massachusetts (A.T.C., C.I.B., E.E.S., J.K.S.).
• Ann. Intern. Med. 2021 Jun 1; 174 (6): 747757747-757.

BackgroundTotal knee replacement (TKR) is an effective and cost-effective strategy for treating end-stage knee osteoarthritis. Greater risk for complications among TKR recipients with a body mass index (BMI) of 40 kg/m2 or greater has raised concerns about the value of TKR in this population.ObjectiveTo assess the value of TKR in recipients with a BMI of 40 kg/m2 or greater using a cost-effectiveness analysis.DesignOsteoarthritis Policy Model to assess long-term clinical benefits, costs, and cost-effectiveness of TKR in patients with a BMI of 40 kg/m2 or greater.Data SourcesTotal knee replacement parameters from longitudinal studies and published literature, and costs from Medicare Physician Fee Schedules, the Healthcare Cost and Utilization Project, and published data.Target PopulationRecipients of TKR with a BMI of 40 kg/m2 or greater in the United States.Time HorizonLifetime.PerspectiveHealth care sector.InterventionTotal knee replacement.Outcome MeasuresCost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually.Results Of Base Case AnalysisTotal knee replacement increased QALYs by 0.71 year and lifetime medical costs by $25 200 among patients aged 50 to 65 years with a BMI of 40 kg/m2 or greater, resulting in an ICER of $35 200. Total knee replacement in patients older than 65 years with a BMI of 40 kg/m2 or greater increased QALYs by 0.39 year and costs by $21 100, resulting in an ICER of $54 100.Results Of Sensitivity AnalysisIn TKR recipients with a BMI of 40 kg/m2 or greater and diabetes and cardiovascular disease, ICERs were below $75 000 per QALY. Results were most sensitive to complication rates and preoperative pain levels. In the probabilistic sensitivity analysis, at a $55 000-per-QALY willingness-to-pay threshold, TKR had a 100% and 90% likelihood of being a cost-effective strategy for patients aged 50 to 65 years and patients older than 65 years, respectively.LimitationData are derived from several sources.ConclusionFrom a cost-effectiveness perspective, TKR offers good value in patients with a BMI of 40 kg/m2 or greater, including those with multiple comorbidities.Primary Funding SourceNational Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.

21 keywords...

hide…