Authors (including presenting author) :
Chan KKY(1), Li WG(1), Lee SY(1), Sit YK(1), Yip SC(1), Wong KF(1), Li W(1)
Affiliation :
Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital
Introduction :
Total knee replacement for end-stage osteoarthritis brings about improvements in pain and physical function. This procedure in Hong Kong’s public sector was generally performed for patients with knee pain causing severe functional debilitation, it will be of public interest to investigate whether it is a cost effective procedure from a societal perspective.
Objectives :
We aim to evaluate the impact of total knee replacement on quality of life in people with end stage knee osteoarthritis in a public healthcare setting, and to estimate associated differences in lifetime costs and quality adjusted life years (QALYs) according to level of symptoms and compare it with that of overseas countries.
Methodology :
431 cases of total knee replacement performed at our joint replacement centre in 2013 were reviewed. A Markov model was used to estimate the value of total knee replacement for patients with end-stage osteoarthritis of the knee by comparing direct medical costs between surgical and nonsurgical treatment scenarios. Direct medical costs and quality-of-life measures were incorporated into the Markov model to estimate the impact of total knee replacement on costs over patients’ lifetimes and quality-adjusted life years. Generic (SF-12) and osteoarthritis specific quality of life measured over 24 & 60 months, model based QALYs, costs, and incremental cost effectiveness ratios (ICER) were measured.
Result & Outcome :
Compared with nonsurgical treatment, total knee replacement increased lifetime direct costs by a mean of $80624 (net present value in 2018 HK dollars). Patients reviewed in our study showed significant improvements in both quality of life scores and functional scores over the pre-operative baseline: 11.54 for SF-12 physical component summary and 5.74 for SF-12 mental component summary; -36.49 for Western Ontario and McMaster Universities arthritis index (WOMAC); 22.24 for knee injury and osteoarthritis outcome score (KOOS). The averaged gain in utility value (SF-6D) was 0.10 and the QALY gained was 0.154. In our threshold analysis, total knee replacement showed an ICER of HKD$778000 /QALY, which is well below the established US cost effectiveness thresholds. The average length of stay was 8.81 days. In terms of complications, there was one case of non-fatal pulmonary embolism, eight cases of superficial wound infection and 1 case of deep surgical site infection. Total knee replacement for end-stage osteoarthritis in our joint replacement centre was shown to be a cost effective procedure.
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