التفاصيل البيبلوغرافية
| العنوان: |
The Value of Total Knee Replacement in Patients With Knee Osteoarthritis and a Body Mass Index of 40 kg/m2 or Greater : A Cost-Effectiveness Analysis. |
| المؤلفون: |
Chen, Angela T., Bronsther, Corin I., Stanley, Elizabeth E., Paltiel, A. David, Sullivan, James K., Collins, Jamie E., Neogi, Tuhina, Katz, Jeffrey N., Losina, Elena |
| المصدر: |
Annals of Internal Medicine; 6/15/2021, Vol. 174 Issue 6, p747-757, 11p, 3 Charts, 1 Graph |
| مصطلحات موضوعية: |
TOTAL knee replacement, BODY mass index, PREOPERATIVE risk factors, CARDIOVASCULAR diseases, COST effectiveness, PAIN management, KNEE diseases, MORBID obesity, SURGICAL complications, OSTEOARTHRITIS, RESEARCH funding, QUALITY-adjusted life years, DISEASE complications |
| الشركة/الكيان: |
NATIONAL Institutes of Health (U.S.) |
| مستخلص: |
Background: Total knee replacement (TKR) is an effective and cost-effective strategy for treating end-stage knee osteoarthritis. Greater risk for complications among TKR recipients with a body mass index (BMI) of 40 kg/m2 or greater has raised concerns about the value of TKR in this population.Objective: To assess the value of TKR in recipients with a BMI of 40 kg/m2 or greater using a cost-effectiveness analysis.Design: Osteoarthritis Policy Model to assess long-term clinical benefits, costs, and cost-effectiveness of TKR in patients with a BMI of 40 kg/m2 or greater.Data Sources: Total knee replacement parameters from longitudinal studies and published literature, and costs from Medicare Physician Fee Schedules, the Healthcare Cost and Utilization Project, and published data.Target Population: Recipients of TKR with a BMI of 40 kg/m2 or greater in the United States.Time Horizon: Lifetime.Perspective: Health care sector.Intervention: Total knee replacement.Outcome Measures: Cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually.Results Of Base-case Analysis: Total knee replacement increased QALYs by 0.71 year and lifetime medical costs by $25 200 among patients aged 50 to 65 years with a BMI of 40 kg/m2 or greater, resulting in an ICER of $35 200. Total knee replacement in patients older than 65 years with a BMI of 40 kg/m2 or greater increased QALYs by 0.39 year and costs by $21 100, resulting in an ICER of $54 100.Results Of Sensitivity Analysis: In TKR recipients with a BMI of 40 kg/m2 or greater and diabetes and cardiovascular disease, ICERs were below $75 000 per QALY. Results were most sensitive to complication rates and preoperative pain levels. In the probabilistic sensitivity analysis, at a $55 000-per-QALY willingness-to-pay threshold, TKR had a 100% and 90% likelihood of being a cost-effective strategy for patients aged 50 to 65 years and patients older than 65 years, respectively.Limitation: Data are derived from several sources.Conclusion: From a cost-effectiveness perspective, TKR offers good value in patients with a BMI of 40 kg/m2 or greater, including those with multiple comorbidities.Primary Funding Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
