Optimized Multisurface Osteochondral Allograft Transplantation and Unicompartmental Knee Arthroplasty Are Associated With Potential Advantages in Direct Comparative Cost-Effectiveness Over Total Knee Arthroplasty in a 30-Year Economic Analysis Model of Active Middle-Aged Patients With Complex Articular Disorders of the Knee.

PURPOSE: To perform comparative cost-effectiveness assessments through 30-year follow-up after multisurface osteochondral allograft transplantation (mOCAT), unicompartmental knee arthroplasty (UKA), or total knee arthroplasty (TKA) in a theoretical cohort of middle-aged patients with symptomatic complex articular disorders in the knee.

METHODS

A Markov cohort model was designed and used to evaluate the comparative cost-effectiveness of mOCAT, UKA, and TKA over a 30-year follow-up period in a theoretical patient population of active 40-year-olds based on quality-adjusted life year, incremental cost-effectiveness ratio, and willingness-to-pay analyses.

RESULTS

Among all surgical procedures analyzed, mOCAT was associated with the highest costs ($111,721 at 30 years), whereas UKA was associated with the lowest costs ($31,072 at 30 years). UKA was determined to be the most cost-effective of all procedures analyzed when comparing direct costs based on incremental cost-effectiveness ratio using a willingness-to-pay threshold of $50,000. Despite the relatively high direct costs, optimized mOCAT yielded the greatest benefits relative to TKA with respect to cumulative quality-adjusted life year differences throughout the study period modeled, indicating a sustained and clinically meaningful benefit. In addition, optimized mOCAT showed a clinically meaningful improvement over UKA in exceeding the cumulative minimal clinically important difference threshold, but only during the first 10 years after surgery. Sex-stratified analyses showed minor differences in incremental cost-effectiveness ratio estimates between men and women, but the overall cost-effectiveness conclusions remained unchanged.

CONCLUSIONS

The results of this study provide computational data in support of optimized mOCAT and UKA being associated with potential advantages in direct comparative cost-effectiveness over TKA in a 30-year economic analysis model for a theoretical population of active middle-aged patients with complex articular disorders of the knee.

LEVEL OF EVIDENCE: Level IV, economic analysis.