Cost-effectiveness of unicondylar versus total knee arthroplasty: a Markov model analysis.
BACKGROUND
Unicondylar knee arthroplasty (UKA) is believed to lead to less morbidity and enhanced functional outcomes when compared with total knee arthroplasty (TKA). Conversely, UKA is also associated with a higher revision risk than TKA. In order to further clarify the key differences between these separate procedures, the current study assessing the cost-effectiveness of UKA versus TKA was undertaken.


METHODS
A state-transition Markov model was developed to compare the cost-effectiveness of UKA versus TKA for unicondylar osteoarthritis using a Belgian payer's perspective. The model was designed to include the possibility of two revision procedures. Model estimates were obtained through literature review and revision rates were based on registry data. Threshold analysis and probabilistic sensitivity analysis were performed to assess the model's robustness.


RESULTS
UKA was associated with a cost reduction of €2,807 and a utility gain of 0.04 quality-adjusted life years in comparison with TKA. Analysis determined that the model is sensitive to clinical effectiveness, and that a marginal reduction in the clinical performance of UKA would lead to TKA being the more cost-effective solution.


CONCLUSIONS
UKA yields clear advantages in terms of costs and marginal advantages in terms of health effects, in comparison with TKA.
Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Belgium. Electronic address: geert.peersman@telenet.be.
Geert
G
Peersman
Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Belgium.
Wouter
W
Jak
Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Belgium.
Tom
T
Vandenlangenbergh
Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Belgium.
Christophe
C
Jans
Institut du Genou, Clinique Hartmann, Neuilly sur Seine, Paris, France.
Philippe
P
Cartier
AMR Advanced Medical Research, 8708 Männedorf, Switzerland.
Peter
P
Fennema
D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D003362:Cost-Benefit Analysis; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008390:Markov Chains; D020370:Osteoarthritis, Knee / Q000191:economics* / Q000601:surgery; D012042:Registries; D012086:Reoperation / Q000191:economics* / Q000706:statistics & numerical data
Cost-effectiveness; Knee; Register; Total knee arthroplasty; Unicondylar knee arthroplasty