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Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales.

Burn, E; Liddle, AD; Hamilton, TW; Judge, A; Pandit, HG; Murray, DW; Pinedo-Villanueva, R; (2018) Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales. BMJ Open , 8 (4) , Article e020977. 10.1136/bmjopen-2017-020977. Green open access

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Abstract

OBJECTIVES: To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR). DESIGN: A lifetime Markov model provided the framework for the analysis. SETTING: Data from the National Joint Registry (NJR) for England and Wales primarily informed the analysis. PARTICIPANTS: Propensity score matched patients in the NJR who received either a UKR or TKR. INTERVENTIONS: UKR is a less invasive alternative to TKR, where only the compartment affected by osteoarthritis is replaced. PRIMARY OUTCOME MEASURES: Incremental quality-adjusted life years (QALYs) and healthcare system costs. RESULTS: The provision of UKR is expected to lead to a gain in QALYs compared with TKR for all age and gender subgroups (male: <60 years: 0.12, 60-75 years: 0.20, 75+ years: 0.19; female: <60 years: 0.10, 60-75 years: 0.28, 75+ years: 0.44) and a reduction in costs (male: <60: £-1223, 60-75 years: £-1355, 75+ years: £-2005; female: <60 years: £-601, 60-75 years: £-935, 75+ years: £-1102 per patient over the lifetime). UKR is expected to lead to a reduction in QALYs compared with TKR when performed by surgeons with low UKR utilisation but an increase among those with high utilisation (<10%, median 6%: -0.04, ≥10%, median 27%: 0.26). Regardless of surgeon usage, costs associated with UKR are expected to be lower than those of TKR (<10%: £-127, ≥10%: £-758). CONCLUSIONS: UKR can be expected to generate better health outcomes and lower lifetime costs than TKR. Surgeon usage of UKR does, however, have a significant impact on the cost-effectiveness of the procedure. To achieve the best results, surgeons need to perform a sufficient proportion of knee replacements as UKR. Low usage surgeons may therefore need to broaden their indications for UKR.

Type: Article
Title: Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales.
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjopen-2017-020977
Publisher version: http://dx.doi.org/10.1136/bmjopen-2017-020977
Language: English
Additional information: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Keywords: Knee, osteoarthritis, total knee replacement, unicompartmental knee replacement
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10050593
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