Cost-effectiveness analysis of total ankle arthroplasty

Area of Science:

• Orthopedic surgery
• Health economics
• Biomedical engineering

Background:

• Growing interest in total ankle arthroplasty (TAA) as an alternative to ankle fusion for end-stage ankle arthritis.
• Expanding use of TAA despite limited long-term clinical outcome data.
• Need to evaluate the cost-effectiveness of TAA based on current literature.

Purpose of the Study:

• To assess if existing literature supports the increasing use of TAA.
• To identify durability and functional thresholds for TAA that would justify wider adoption.

Main Methods:

• Developed a decision model for ankle arthritis treatment.
• Reviewed literature for outcomes and probabilities of ankle fusion vs. TAA.
• Assigned quality of life utility factors and calculated quality-adjusted life years (QALYs).
• Estimated costs using Medicare data and performed sensitivity analysis.

Main Results:

• Reference case: TAA cost-effectiveness ratio of $18,419 per QALY gained (0.52 QALYs at $9578 cost).
• This ratio is favorable compared to other interventions.
• Cost-effectiveness exceeds $50,000/QALY if prosthesis fails before 7 years or functional advantages are not realized.

Conclusions:

• Current literature lacks definitive proof of TAA's cost-effectiveness due to uncertain durability and function.
• TAA shows potential as a cost-effective alternative to ankle fusion.
• Future clinical trials demonstrating TAA meets durability and functional thresholds are needed for stronger justification.