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Patellar Resurfacing in Total Knee Arthroplasty: A Cost-Effectiveness Analysis
Colleen A Weeks1, Jacquelyn D Marsh1, Steven J MacDonald1
1Department of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
The Journal of Arthroplasty
|August 21, 2018
Summary
Patellar resurfacing in total knee arthroplasty (TKA) is cost-effective, improving quality of life and reducing revision rates. This analysis suggests resurfacing offers superior outcomes compared to retaining the patella.
Area of Science:
- Orthopedic Surgery
- Health Economics
Background:
- Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis.
- The role of patellar resurfacing during TKA remains a subject of clinical debate.
- Estimating the long-term cost-effectiveness of patellar resurfacing is crucial for healthcare decision-making.
Purpose of the Study:
- To estimate the cost-effectiveness of patellar resurfacing versus nonresurfacing in primary total knee arthroplasty.
- To compare postoperative health states and quality-adjusted life years (QALYs) between the two surgical approaches.
- To provide insights for healthcare payers regarding the economic value of patellar resurfacing.
Main Methods:
- A decision analytic model was developed to simulate a hypothetical TKA cohort.
- Data from the 2014 Australian Registry informed the model parameters.
- Cost-effectiveness was evaluated from a Canadian public healthcare payer perspective, using 2015 USD and a 5% discount rate.
Main Results:
- Total knee arthroplasty with patellar resurfacing was found to be more cost-effective than nonresurfacing.
- Resurfacing resulted in lower costs ($12,917.01 vs $13,296.63) and higher QALYs (6.01 vs 5.37) over 14 years.
- Sensitivity analysis indicated that cost-effectiveness was sensitive to the rate of secondary patellar resurfacing.
Conclusions:
- Patellar resurfacing in TKA appears to be a cost-effective strategy over a 14-year period.
- The improved cost-effectiveness is attributed to lower revision rates associated with resurfaced TKAs.
- While resurfacing may improve quality of life, the model's limitations include the availability and validity of long-term utility data for TKA.
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