title: Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy.
abstract: OBJECTIVE
  To compare the age-based cost-effectiveness of total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and high tibial osteotomy (HTO) for the treatment of medial compartment knee osteoarthritis (MCOA).
  
  
  METHODS
  A Markov model was used to simulate theoretical cohorts of patients 40, 50, 60, and 70 years of age undergoing primary TKA, UKA, or HTO. Costs and outcomes associated with initial and subsequent interventions were estimated by following these virtual cohorts over a 10-year period. Revision and mortality rates, costs, and functional outcome data were estimated from a systematic review of the literature. Probabilistic analysis was conducted to accommodate these parameters' inherent uncertainty, and both discrete and probabilistic sensitivity analyses were utilized to assess the robustness of the model's outputs to changes in key variables.
  
  
  RESULTS
  HTO was most likely to be cost-effective in cohorts under 60, and UKA most likely in those 60 and over. Probabilistic results did not indicate one intervention to be significantly more cost-effective than another. The model was exquisitely sensitive to changes in utility (functional outcome), somewhat sensitive to changes in cost, and least sensitive to changes in 10-year revision risk.
  
  
  CONCLUSIONS
  HTO may be the most cost-effective option when treating MCOA in younger patients, while UKA may be preferred in older patients. Functional utility is the primary driver of the cost-effectiveness of these interventions. For the clinician, this study supports HTO as a competitive treatment option in young patient populations. It also validates each one of the three interventions considered as potentially optimal, depending heavily on patient preferences and functional utility derived over time.
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Smith
authors.affiliation: Tulane University, New Orleans, LA, USA.
authors.forename: Joni
authors.initials: J
authors.lastname: Steinberg
authors.affiliation: University of Cambridge, Cambridge, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Scholtes
authors.affiliation: Norfolk and Norwich University Hospital NHS Foundation Trust, University of East Anglia, Colney Lane, Norwich, NR4 2UY, UK. imcnamara@doctors.org.uk.
authors.forename: Iain R
authors.initials: IR
authors.lastname: Mcnamara
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008390:Markov Chains; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy / Q000191:economics* / Q000379:methods; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cost-effectiveness; High tibial osteotomy; Medial compartment osteoarthritis; Osteoarthritis; Total knee arthroplasty; Unicompartmental knee arthroplasty