Cost-efficacy of Knee Cartilage Defect Treatments in the United States
| Autor: | David C. Flanigan, Joshua S. Everhart, Andrew B. Campbell, Moneer M. Abouljoud, J Caid Kirven |
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| Rok vydání: | 2019 |
| Předmět: |
Reoperation
medicine.medical_specialty Knee Joint Cost-Benefit Analysis medicine.medical_treatment Knee replacement Physical Therapy Sports Therapy and Rehabilitation 03 medical and health sciences 0302 clinical medicine Humans Medicine Orthopedic Procedures Orthopedics and Sports Medicine 030222 orthopedics Thesaurus (information retrieval) business.industry Patella 030229 sport sciences Cost efficacy medicine.disease Osteochondritis dissecans United States Knee cartilage Cartilage Treatment Outcome Physical therapy business Cartilage Diseases |
| Zdroj: | The American Journal of Sports Medicine. 48:242-251 |
| ISSN: | 1552-3365 0363-5465 |
| Popis: | Background: Multiple knee cartilage defect treatments are available in the United States, although the cost-efficacy of these therapies in various clinical scenarios is not well understood. Purpose/Hypothesis: The purpose was to determine cost-efficacy of cartilage therapies in the United States with available mid- or long-term outcomes data. The authors hypothesized that cartilage treatment strategies currently approved for commercial use in the United States will be cost-effective, as defined by a cost Study Design: Systematic review. Methods: A systematic search was performed for prospective cartilage treatment outcome studies of therapies commercially available in the United States with minimum 5-year follow-up and report of pre- and posttreatment International Knee Documentation Committee subjective scores. Cost-efficacy over 10 years was determined with Markov modeling and consideration of early reoperation or revision surgery for treatment failure. Results: Twenty-two studies were included, with available outcomes data on microfracture, osteochondral autograft, osteochondral allograft (OCA), autologous chondrocyte implantation (ACI), and matrix-induced ACI. Mean improvement in International Knee Documentation Committee subjective scores at final follow-up ranged from 17.7 for microfracture of defects >3 cm2 to 36.0 for OCA of bipolar lesions. Failure rates ranged from 3 cm2 ($127,782) became cost-ineffective over 10 years. Conclusion: Currently employed treatments for knee cartilage defects in the United States are cost-effective in most clinically acceptable applications. Microfracture is not a cost-effective initial treatment of defects >3 cm2. OCA transplantation of the patella or bipolar lesions is potentially cost-ineffective and should be used judiciously. |
| Databáze: | OpenAIRE |
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