The Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Brigham and Women's Hospital, Boston, Massachusetts (A.T.C., C.I.B., E.E.S., J.K.S.).
Yale School of Public Health, New Haven, Connecticut (A.D.P.).
Ann Intern Med. 2021 Jun;174(6):747-757. doi: 10.7326/M20-4722. Epub 2021 Mar 23.
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/m or greater has raised concerns about the value of TKR in this population.
To assess the value of TKR in recipients with a BMI of 40 kg/m or greater using a cost-effectiveness analysis.
Osteoarthritis Policy Model to assess long-term clinical benefits, costs, and cost-effectiveness of TKR in patients with a BMI of 40 kg/m or greater.
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.
Recipients of TKR with a BMI of 40 kg/m or greater in the United States.
Lifetime.
Health care sector.
Total knee replacement.
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/m or greater, resulting in an ICER of $35 200. Total knee replacement in patients older than 65 years with a BMI of 40 kg/m or greater increased QALYs by 0.39 year and costs by $21 100, resulting in an ICER of $54 100.
In TKR recipients with a BMI of 40 kg/m 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.
Data are derived from several sources.
From a cost-effectiveness perspective, TKR offers good value in patients with a BMI of 40 kg/m or greater, including those with multiple comorbidities.
National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.
全膝关节置换术（TKR）是治疗终末期膝骨关节炎的一种有效且具有成本效益的策略。BMI 为 40kg/m² 或更高的 TKR 接受者发生并发症的风险更高，这引发了人们对该人群中 TKR 价值的担忧。
使用成本效益分析评估 BMI 为 40kg/m² 或更高的 TKR 接受者的价值。
使用 Osteoarthritis Policy Model 评估 BMI 为 40kg/m² 或更高的患者中 TKR 的长期临床获益、成本和成本效益。
来自纵向研究和已发表文献的全膝关节置换术参数，以及 Medicare 医师费用表、医疗保健成本和利用项目和已发表数据中的成本。
美国 BMI 为 40kg/m² 或更高的 TKR 接受者。
终身。
医疗保健部门。
全膝关节置换术。
成本、质量调整生命年（QALYs）和增量成本效益比（ICER），每年贴现 3%。
50 岁至 65 岁 BMI 为 40kg/m² 或更高的患者中，TKR 使 QALYs 增加了 0.71 年，使终生医疗费用增加了 25200 美元，导致 ICER 为 35200 美元。65 岁以上 BMI 为 40kg/m² 或更高的患者中，TKR 使 QALYs 增加了 0.39 年，使终生医疗费用增加了 21100 美元，导致 ICER 为 54100 美元。
BMI 为 40kg/m² 或更高且患有糖尿病和心血管疾病的 TKR 接受者中，ICER 低于每 QALY 75000 美元。结果对并发症发生率和术前疼痛水平最为敏感。在概率敏感性分析中，在 55000 美元/QALY 的支付意愿阈值下，TKR 对于 50 至 65 岁的患者和 65 岁以上的患者分别具有 100%和 90%的可能性成为具有成本效益的治疗策略。
数据来自多个来源。
从成本效益的角度来看，TKR 在 BMI 为 40kg/m² 或更高的患者中具有很好的价值，包括患有多种合并症的患者。
美国国立卫生研究院下属的国家关节炎和肌肉骨骼及皮肤病研究所。
