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Cost Analysis of Radioactive Versus Arthroscopic Synovectomy in Haemophilia: A Brazilian Modelling Approach
Sylvia Thomas1, Mariana Battazza2, Vinicius Bednarczuk de Oliveira3
1Radiology Department, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
Introduction:
Radioactive synovectomy (RSO) is an alternative to arthroscopic synovectomy (AR), for treating synovitis. RSO reduces the number of hemarthroses, being less invasive and less costly.
Objective:
To analyse the costs of RSO compared to AR in the treatment of patients with haemophilia in Brazil, using real-world data (RSO) and modelling (AR).
Methodology:
We reviewed data from patients with haemophilic synovitis who underwent RSO in two centres in Brazil, from 2003 to 2019. Data of RSO came from actual patients, while those of AR were estimated. We analysed the expenditures for clotting factor concentrates (CFC), hospital stays, and postoperative care. Cost savings of RSO were based on the frequency of hemarthroses 6 months pre and post procedure. The radioisotopes used were Yttrium90 and Samarium153. The Pettersson score was used to assess the severity of haemophilic arthropathy.
Results:
The study included 750 patients who underwent RSO in knees (N = 349), ankles (N = 190), and elbows (N = 211). The median age of patients was 12 years. For RSO in knees, the costs were nearly USD 6000, while AR costs were USD 49,000. The overall costs with CFC for knee hemarthroses decreased from USD 43,506.94 to USD 6,018.64/patient/semester post-RSO. Similar savings were seen with the ankle and elbow.
Conclusion:
RSO offers a clinically effective and economically advantageous alternative compared to AR, for haemophilic synovitis. Integrating RSO into treatment protocols can reduce healthcare costs and improve patient outcomes. Further work is needed, to confirm these findings in other countries.
