Decision Analysis in the Management of Hip and Knee Osteoarthritis: A Systematic Review

Decision analysis is an increasingly used tool to guide policymakers and clinicians toward objective decision-making in uncertain clinical scenarios by analyzing the cost-effectiveness and health benefits of treatment modalities. In this systematic review, we summarize and appraise the current use of decision analysis in the management of hip and knee osteoarthritis (OA), the leading source of disability and societal costs in patients over 70. Publications involving decision analysis modelling for hip and knee OA between 1995 and 2021 were included. Among 54 included studies, there were 33 knee- and 18 hip OA-related models, while three were overlapping. Included articles primarily used Markov decision models (39), followed by simple decision trees (eight), microsimulations (five), and discrete event simulations (two) to compare OA treatment modalities. Models most commonly compared surgical procedures and devices (21), surgical versus nonoperative management (12), intraarticular injections (seven), and rehab therapies (five). More than half of all included studies (33) were published in the last five years. This study finds that there has been a large increase in the publication of hip and knee OA-related decision analysis models, particularly over the most recent five years. High-quality decision analysis models incorporate sensitivity and value of information analyses and take on broader, societal perspectives to incorporate utilities, direct costs, and indirect costs of management decisions. Surgeons should be familiar with the principles of decision analysis, which can be used to guide complicated real-world decision-making by incorporating risks and benefits of multiple strategies.