Cost-Effectiveness of Total Knee Arthroplasty vs Nonoperative Management in Normal, Overweight, Obese, Severely Obese, Morbidly Obese, and Super-Obese Patients: A Markov Model

We estimated the cost-effectiveness of performing total knee arthroplasty (TKA) vs nonoperative management (NM) among 6 body mass index (BMI) cohorts. A Markov model was used to compare the cost-utility of TKA and NM in 6 BMI groups (nonobese [BMI 18.5-24.9], overweight [25-29.9], obese [30-34.9], s...

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Bibliographic Details
Published in:The Journal of arthroplasty 2018-07, Vol.33 (7), p.S32-S38
Main Authors: Ponnusamy, Karthikeyan E., Vasarhelyi, Edward M., Somerville, Lyndsay, McCalden, Richard W., Marsh, Jacquelyn D.
Format: Article
Language:English
Subjects:
body mass index
cost-effectiveness
economic analysis
obesity
total knee arthroplasty
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Summary:We estimated the cost-effectiveness of performing total knee arthroplasty (TKA) vs nonoperative management (NM) among 6 body mass index (BMI) cohorts. A Markov model was used to compare the cost-utility of TKA and NM in 6 BMI groups (nonobese [BMI 18.5-24.9], overweight [25-29.9], obese [30-34.9], severely obese [35-39.9], morbidly obese [40-49.9], and super-obese [50+] patients) over a 15-year period. Model parameters for transition probability (ie, revision, re-revision, death), utility, and costs were estimated from the literature. Direct medical costs but not indirect societal costs were included in the model. Costs and utilities were discounted 3% annually. The primary outcome was the incremental cost-effectiveness ratio (ICER) of TKA vs NM. One-way and probabilistic sensitivity analyses of the model parameters were performed to determine the robustness of the model. Over the 15-year period, the ICERs for the TKA vs NM for the different BMI categories were nonobese ($3317/quality-adjusted life years [QALYs]), overweight ($2837/QALY), obese ($2947/QALY), severely obese ($3536/QALY), morbidly obese ($5531/QALY), and super-obese ($11,878/QALY). The higher BMI groups tended to have higher incremental QALYs and also higher incremental costs. The probabilistic sensitivity analysis with an ICER threshold of $30,000/QALY showed that TKA would be cost-effective in 100% of simulations of patients with a BMI
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2018.02.031