Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6):1739-1753. doi: 10.1007/s00167-019-05392-8. Epub 2019 Feb 5.
Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. They are used to repair combined defects of articular cartilage and bone. Such defects often occur in people far too young to have knee arthroplasty, for whom the main alternative to OCA is conservative symptomatic care, which will not prevent development of osteoarthritis. The aim of this report was to assess the cost-effectiveness of osteochondral allograft transplantation in the knee.
Systematic review of evidence on clinical effectiveness and economic modelling.
The evidence on osteochondral allograft transplantation comes from observational studies, but often based on good quality prospective registries of all patients having such surgery. Without controlled trials, it was necessary to use historical cohorts to assess the effect of osteochondral grafts. There is good evidence that OCA are clinically effective with a high graft survival rate over 20 years. If an OCA graft fails, there is some evidence that revision with a second OCA is also effective, though less so than primary OCA. Economic modelling showed that osteochondral allograft transplantation was highly cost-effective, with costs per quality adjusted life year much lower than many other treatments considered cost effective.
Osteochondral allograft transplantation appears highly cost-effective though the cost per quality adjusted life year varies according to the widely varying costs of allografts. Based on one small study, revision OCA also appears very cost-effective, but more evidence is needed.
II.
异体骨软骨移植（OCA）由一层透明软骨和一层下方的骨组成。它们用于修复关节软骨和骨的联合缺损。此类缺损通常发生在年龄太小而无法接受膝关节置换术的人群中，对于这些患者，OCA 的主要替代方法是保守对症治疗，这并不能预防骨关节炎的发展。本报告的目的是评估膝关节异体骨软骨移植的成本效益。
对临床疗效和经济建模的证据进行系统评价。
异体骨软骨移植的证据来自观察性研究，但通常基于对接受此类手术的所有患者进行的高质量前瞻性登记。由于没有对照试验，因此有必要使用历史队列来评估骨软骨移植物的效果。有充分的证据表明，OCA 在临床上是有效的，20 多年来移植物存活率很高。如果 OCA 移植物失败，有一些证据表明使用第二个 OCA 进行翻修也有效，尽管不如初次 OCA 有效。经济建模表明，异体骨软骨移植具有很高的成本效益，每质量调整生命年的成本远低于许多其他被认为具有成本效益的治疗方法。
尽管每质量调整生命年的成本因异体移植物的广泛差异而有所不同，但异体骨软骨移植似乎具有很高的成本效益。基于一项小型研究，翻修 OCA 也具有非常高的成本效益，但需要更多的证据。
II。
