A cost-effectiveness analysis after implementation of a fast-track protocol for total knee arthroplasty

Area of Science:

• Orthopedic surgery
• Health economics
• Patient outcomes research

Background:

• Fast-track protocols in arthroplasty aim to improve patient recovery and reduce hospital stays.
• Limited research exists on the long-term cost-effectiveness and quality of life impacts of fast-track total knee arthroplasty (TKA).
• This study addresses the need to evaluate fast-track TKA's effects on functional outcomes, costs, and quality of life up to 12 months postoperatively.

Purpose of the Study:

• To analyze the cost-effectiveness of fast-track TKA compared to non-fast-track protocols.
• To assess the impact of fast-track TKA on functional outcomes, length of stay, and thromboembolic complications.
• To evaluate health-related quality of life using Quality-Adjusted Life Years (QALYs) at 12 months post-surgery.

Main Methods:

• Retrospective cohort study comparing 403 fast-track TKA patients with 283 non-fast-track TKA patients.
• Data collected included postoperative length of stay, thromboembolic complications, and healthcare production costs.
• Quality of life was measured using EQ-5D questionnaires to derive QALY scores.

Main Results:

• No significant differences in functional outcome or quality of life were observed between the groups.
• Fast-track TKA reduced median length of stay from five days to three days.
• The fast-track protocol resulted in an average cost reduction of €268 per patient, with comparable QALY scores (0.85 vs. 0.84).

Conclusions:

• Fast-track TKA is a safe and cost-effective strategy, demonstrating high QALY and reduced medical costs.
• The protocol effectively shortens hospital stays without increasing the rate of thromboembolic complications.
• This study provides novel, long-term (12-month) data on the functional and quality-of-life benefits of fast-track TKA.