title: Early health economic modelling of single-stage cartilage repair. Guiding implementation of technologies in regenerative medicine.
abstract: Both the complexity of clinically applied tissue engineering techniques for articular cartilage repair - such as autologous chondrocyte implantation (ACI) - plus increasing healthcare costs, and market competition, are forcing a shift in focus from two-stage to single-stage interventions that are more cost-effective. Early health economic models are expected to provide essential insight in the parameters driving the cost-effectiveness of new interventions before they are introduced into clinical practice. The present study estimated the likely incremental cost-effectiveness ratio (ICER) of a new investigator-driven single-stage procedure (IMPACT) compared with both microfracture and ACI, and identified those parameters that affect the cost-effectiveness. A decision tree with clinical health states was constructed. The ICER was calculated by dividing the incremental societal costs by the incremental Quality Adjusted Life Years (QALYs). Costs were determined from a societal perspective. A headroom analysis was performed to determine the maximum price of IMPACT compared with both ACI and microfracture, assuming a societal willingness to pay (WTP) of €30 000/QALY. One-way sensitivity analysis was performed to identify those parameters that drive the cost-effectiveness. The societal costs of IMPACT, ACI and microfracture were found to be €11 797, €29 741 and €6081, respectively. An 8% increase in all utilities after IMPACT changes the ICER of IMPACT vs. microfracture from €147 513/QALY to €28 588/QALY. Compared with ACI, IMPACT is less costly, which is largely attributable to the cell expansion procedure that has been rendered redundant. While microfracture can be considered the most cost-effective treatment option for smaller defects, a single-stage tissue engineering procedure can replace ACI to improve the cost-effectiveness for treating larger defects, especially if clinical non-inferiority can be achieved. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Tommy S
authors.initials: TS
authors.lastname: de Windt
authors.affiliation: Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Juliette C
authors.initials: JC
authors.lastname: Sorel
authors.affiliation: Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Lucienne A
authors.initials: LA
authors.lastname: Vonk
authors.affiliation: Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.
authors.forename: Michelle M A
authors.initials: MMA
authors.lastname: Kip
authors.affiliation: Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Ijzerman
authors.affiliation: Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, the Netherlands.|MIRA Institute for Biotechnology and Technical Medicine, University of Twente, Enschede, the Netherlands.
authors.forename: Daniel B F
authors.initials: DBF
authors.lastname: Saris
mesh_terms: D002358:Cartilage, Articular / Q000473:pathology*; D019902:Chondrocytes / Q000166:cytology; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D011336:Probability; D019057:Quality-Adjusted Life Years; D044968:Regenerative Medicine / Q000191:economics* / Q000379:methods*; D014945:Wound Healing
keywords: ACI; cost-effectiveness; early health technology assessment; microfracture; single-stage procedure