School of Medicine, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, U.S.A; Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.
School of Medicine, NYU Grossman School of Medicine, New York, New York, U.S.A.
Arthroscopy. 2023 Sep;39(9):2058-2068. doi: 10.1016/j.arthro.2023.02.018. Epub 2023 Mar 2.
To evaluate the cost-effectiveness of 3 isolated meniscal repair (IMR) treatment strategies: platelet-rich plasma (PRP)-augmented IMR, IMR with a marrow venting procedure (MVP), and IMR without biological augmentation.
A Markov model was developed to evaluate the baseline case: a young adult patient meeting the indications for IMR. Health utility values, failure rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing IMR at an outpatient surgery center. Outcome measures included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER).
Total costs of IMR with an MVP were $8,250; PRP-augmented IMR, $12,031; and IMR without PRP or an MVP, $13,326. PRP-augmented IMR resulted in an additional 2.16 QALYs, whereas IMR with an MVP produced slightly fewer QALYs, at 2.13. Non-augmented repair produced a modeled gain of 2.02 QALYs. The ICER comparing PRP-augmented IMR versus MVP-augmented IMR was $161,742/QALY, which fell well above the $50,000 willingness-to-pay threshold.
IMR with biological augmentation (MVP or PRP) resulted in a higher number of QALYs and lower costs than non-augmented IMR, suggesting that biological augmentation is cost-effective. Total costs of IMR with an MVP were significantly lower than those of PRP-augmented IMR, whereas the number of additional QALYs produced by PRP-augmented IMR was only slightly higher than that produced by IMR with an MVP. As a result, neither treatment dominated over the other. However, because the ICER of PRP-augmented IMR fell well above the $50,000 willingness-to-pay threshold, IMR with an MVP was determined to be the overall cost-effective treatment strategy in the setting of young adult patients with isolated meniscal tears.
Level III, economic and decision analysis.
评估 3 种孤立半月板修复（IMR）治疗策略的成本效益，即富含血小板的血浆（PRP）增强 IMR、伴骨髓腔减压术（MVP）的 IMR 和不进行生物增强的 IMR。
建立了一个马尔可夫模型来评估基础情况：符合 IMR 适应证的年轻成年患者。健康效用值、失败率和转移概率均来自已发表的文献。成本基于在门诊手术中心接受 IMR 的典型患者确定。结果指标包括成本、质量调整生命年（QALY）和增量成本效益比（ICER）。
伴 MVP 的 IMR 总费用为 8250 美元；PRP 增强的 IMR 费用为 12031 美元；不进行 PRP 或 MVP 的 IMR 费用为 13326 美元。PRP 增强的 IMR 增加了 2.16 个 QALY，而伴 MVP 的 IMR 则略有较少的 QALY，为 2.13。非增强修复可获得 2.02 个 QALY 的模型增益。PRP 增强的 IMR 与伴 MVP 的 IMR 相比，ICER 为 161742 美元/QALY，远高于 50000 美元的支付意愿阈值。
与非增强的 IMR 相比，伴生物增强（MVP 或 PRP）的 IMR 可获得更高的 QALY 和更低的成本，表明生物增强是具有成本效益的。伴 MVP 的 IMR 的总成本明显低于 PRP 增强的 IMR，而 PRP 增强的 IMR 所产生的额外 QALY 数量仅略高于伴 MVP 的 IMR。因此，两种治疗方法均未占主导地位。但是，由于 PRP 增强的 IMR 的 ICER 远高于 50000 美元的支付意愿阈值，因此在伴有孤立半月板撕裂的年轻成年患者中，伴 MVP 的 IMR 被确定为总体上具有成本效益的治疗策略。
三级，经济和决策分析。
