Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
Int J Technol Assess Health Care. 2023 Jan 18;39(1):e7. doi: 10.1017/S0266462322003361.
Numerous studies have shown that arthroscopic partial meniscectomy (APM) is not (cost-) effective in patients with symptoms attributed to a degenerative meniscus tear. We aimed to assess the budget impact of reducing APM in routine clinical practice in this population.
A patient-level state transition model was developed to simulate patients recently diagnosed with a degenerative meniscus tear. Three strategies were compared: "current guideline" (i.e., postpone surgery to at least 3 months after diagnosis), "APM at any time" (i.e., APM available directly after diagnosis), and "nonsurgical" (i.e., APM no longer performed). Total societal costs over 5 years were calculated to determine the budget impact. Probabilistic and deterministic sensitivity analyses were conducted to address uncertainty.
The average cost per patient over 5 years were EUR 5,077, EUR 4,577, and EUR 4,218, for the "APM at any time," "current guideline," and "nonsurgical" strategy, respectively. Removing APM from the treatment mix (i.e., 30,000 patients per year) in the Netherlands, resulted in a reduction in health care expenditures of EUR 54 million (95 percent confidence interval [CI] EUR 38 million-EUR 70 million) compared to the "current guideline strategy" and EUR 129 million (95 percent CI EUR 102 million-EUR 156 million) compared to the "APM at any time" strategy. Sensitivity analyses showed that uncertainty did not alter our conclusions.
Substantial costs can be saved when APM is no longer performed to treat symptoms attributed to degenerative meniscus tears in the Netherlands. It is therefore recommended to further reduce the use of APM to treat degenerative meniscus tears.
许多研究表明，对于归因于退行性半月板撕裂的症状患者，关节镜下半月板部分切除术（APM）不具有（成本）效益。我们旨在评估在该人群的常规临床实践中减少 APM 的预算影响。
开发了一个患者水平的状态转移模型，以模拟最近被诊断为退行性半月板撕裂的患者。比较了三种策略：“现行指南”（即，至少在诊断后 3 个月后进行手术），“随时进行 APM”（即，诊断后即可进行 APM）和“非手术”（即，不再进行 APM）。计算了 5 年内的总社会成本，以确定预算影响。进行了概率和确定性敏感性分析，以解决不确定性问题。
在 5 年内，每位患者的平均成本分别为“随时进行 APM”策略的 5077 欧元，“现行指南”策略的 4577 欧元和“非手术”策略的 4218 欧元。如果在荷兰将 APM 从治疗方案中删除（即每年 30,000 例患者），与“现行指南”策略相比，可减少医疗保健支出 5400 万欧元（95％置信区间[CI] 3800 万欧元-7000 万欧元），与“随时进行 APM”策略相比，可减少 1.29 亿欧元（95％CI 1.02 亿欧元-1.56 亿欧元）。敏感性分析表明，不确定性并未改变我们的结论。
在荷兰，当不再使用 APM 治疗归因于退行性半月板撕裂的症状时，可以节省大量成本。因此，建议进一步减少 APM 治疗退行性半月板撕裂的使用。
