title: Descriptive analysis of the cost-effectiveness of depressed patients undergoing total knee arthroplasty: an economic decision analysis.
abstract: BACKGROUND
  Recent rising concern about the cost-effectiveness ratio of total knee arthroplasty (TKA) led us to evaluate this successful procedure from the economic perspective, thereby helping policy-makers to conduct medical resource allocation more effectively and efficiently. However, up to now no study has investigated the influence of patients' psychological factors on their evaluation of TKA's cost-effectiveness. Therefore, we decided to determine whether and how depression, which is a common negative psychological factor in the population undergoing TKA, affects their economic evaluation of the procedure.
  
  
  METHODS
  A total of 312 patients who had undergone TKA were graded into three groups based on the level of depression measured by the Center for Epidemiological Studies Depression Scale (CES-D) scores. Clinical effectiveness information was obtained using the WOMAC questionnaire; total costs related to TKA were acquired through interviews with patients and review of their medical records in the computing system.
  
  
  RESULTS
  Patients with high-level depression (3491.9$/QALYS; 95% CI, 3471.1-3491.9$/QALYS) had greater cost-effectiveness compared tothose with low-level (2447.1$/QALYS; 95% CI, 2427.9-2466.3$/QALYS) and middle-level (3027.2$/QALYS; 95% CI, 3011.0-3043.4$/QALYS) depression. We concluded there was a significant positive correlation between cost-effectiveness and the level of depression after TKA (r = 0.703, P = 0.014). Significant differences in the costs of hospital stay, medical treatment, rehabilitation, and outpatient care were detected among the three groups.
  
  
  CONCLUSIONS
  Our study might help policy-makers and clinicians identify which types of patients benefit most from TKA and then advise high-risk patients (high-level depression status in this study) about how to recovery better with limited resource allocation. Preoperative evaluation of patients' psychological state may decrease unnecessary economic burdens and suffering during the recovery period.
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China, Gonglong301@163.com.
authors.forename: Long
authors.initials: L
authors.lastname: Gong
authors.forename: Hua
authors.initials: H
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000523:psychology*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003866:Depressive Disorder / Q000150:complications / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000191:economics / Q000523:psychology* / Q000601:surgery*; D018579:Patient Selection; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome