Across all risk levels, surgery is associated with higher quality-adjusted life expectancy
Elena Losina, Ph.D., of Brigham and Women's Hospital in Boston, and colleagues analyzed claims data from Medicare and cost and outcomes data from national and multinational sources with a Markov, state-transition, computer simulation model. The researchers found that total knee arthroplasty was associated with significant increases in quality-adjusted life years (from 6.822 to 7.957 overall, and from 5.713 to 6.594 in high-risk patients) and that it had an incremental cost-effectiveness ratio of $18,300 per quality-adjusted life year overall and $28,100 per quality-adjusted life year in high-risk patients. Compared to total knee arthroplasty performed at high-volume centers, they found that the surgery was more costly and less effective when performed in low-volume centers across all risks levels. "There is no doubt that total knee arthroplasty will continue to benefit numerous patients with disabling arthritis of the knee by improving their quality of life and allowing them to return to a more active role in society," states the author of an Invited Commentary. "However, concerns about rising procedure volumes and the continual introduction of newer, more expensive total knee arthroplasty implant technologies necessitate careful consideration and evaluation of the incremental cost-effectiveness of these procedures. A multi-stakeholder approach to delivering high-quality, cost-efficient care will be essential to ensuring future generations of patients access to these life-altering procedures." Abstract
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