全膝关节置换术、单髁膝关节置换术和高位胫骨截骨术治疗年轻患者内侧间室膝关节骨关节炎的成本效益：加拿大公共支付方视角
Cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy for medial compartment knee osteoarthritis in young patients: a Canadian public payer perspective.
作者信息
Ruangsomboon Pakpoom, Ruangsomboon Onlak, Tam Davis, Ravi Bheeshma, Ekhtiari Seper, Pincus Daniel, Tomescu Sebastian
机构信息
Sunnybrook Holland Orthopaedic and Arthritic Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada.
出版信息
J Orthop Surg Res. 2025 May 31;20(1):554. doi: 10.1186/s13018-025-05960-4.
BACKGROUND
In medial compartment osteoarthritis (OA) of the knee in young patients who fail conservative treatment, clinical equipoise exists between three surgical strategies: (1) total knee arthroplasty (TKA), (2) unicompartmental knee arthroplasty (UKA), and (3) medial opening wedge high tibial osteotomy (HTO). This study evaluated the cost-effectiveness of three surgical strategies, using a probabilistic Markov model from the Ontario public payer perspective in Canada.
METHODS
A probabilistic Markov model was developed to perform a cost-utility analysis comparing TKA, UKA, and HTO. The base case simulated a 45-year-old Canadian cohort with unilateral medial knee OA over a lifetime horizon. Outcomes included quality-adjusted life months (QALMs), discounted lifetime costs (1.5% annually), incremental cost-effectiveness ratios (ICERs), and net monetary benefit (NMB), reported in 2023 Canadian dollars (CAD, $). A willingness to pay (WTP) threshold of $4,166.67/QALM was applied. Model uncertainty was assessed via 3,000 iterations of probabilistic sensitivity analysis. Scenario analyses using sex-specific mortality rates were also conducted.
RESULTS
Mean costs were $9,157 (TKA), $9,238 (HTO), and $9,419 (UKA). UKA produced the highest QALMs (290.53), followed by TKA (277.02) and HTO (270.88). HTO was absolutely dominated, as it was both more costly and less effective than TKA. Among undominated strategies, UKA yielded an ICER of $19.46/QALM compared to TKA. UKA also had the highest NMB ($1,201,112), outperforming TKA ($1,145,110) and HTO ($1,119,411). UKA was the most cost-effective option in 55.27% of probabilistic simulations, followed by TKA (23.83%) and HTO (20.90%). Scenario analyses with sex-specific mortality showed similar trends.
CONCLUSIONS
UKA is the most cost-effective surgical strategy from a public payer perspective for young patients with medial knee OA. At a WTP of $4,166.67/QALM, UKA balances long-term durability and economic value better than TKA or HTO.
LEVEL OF EVIDENCE
Level III, Model-based economic evaluation.
背景
对于保守治疗失败的年轻患者的膝关节内侧间室骨关节炎（OA），三种手术策略之间存在临床 equipoise：（1）全膝关节置换术（TKA），（2）单髁膝关节置换术（UKA），以及（3）内侧开放楔形高位胫骨截骨术（HTO）。本研究从加拿大安大略省公共支付方的角度，使用概率马尔可夫模型评估了三种手术策略的成本效益。
方法
开发了一个概率马尔可夫模型，以进行比较 TKA、UKA 和 HTO 的成本效用分析。基础病例模拟了一个 45 岁的加拿大队列，其患有单侧膝关节内侧 OA，随访期为一生。结果包括质量调整生命月（QALMs）、贴现终身成本（每年 1.5%）、增量成本效益比（ICERs）和净货币效益（NMB），以 2023 年加拿大元（CAD，$）报告。应用了每 QALM 4,166.67 美元的支付意愿（WTP）阈值。通过 3,000 次概率敏感性分析迭代评估模型不确定性。还进行了使用特定性别死亡率的情景分析。
结果
平均成本分别为 9,157 美元（TKA）、9,238 美元（HTO）和 9,419 美元（UKA）。UKA 产生的 QALMs 最高（290.53），其次是 TKA（277.02）和 HTO（270.88）。HTO 完全处于劣势，因为它比 TKA 成本更高且效果更差。在非劣势策略中，与 TKA 相比，UKA 的 ICER 为每 QALM 19.46 美元。UKA 还具有最高的 NMB（1,201,112 美元），优于 TKA（1,145,110 美元）和 HTO（1,119,411 美元）。在 55.27%的概率模拟中，UKA 是最具成本效益的选择，其次是 TKA（23.83%）和 HTO（20.90%）。使用特定性别死亡率的情景分析显示了类似的趋势。
结论
从公共支付方的角度来看，UKA 是年轻膝关节内侧 OA 患者最具成本效益的手术策略。在每 QALM 4,166.67 美元的 WTP 下，UKA 比 TKA 或 HTO 更好地平衡了长期耐用性和经济价值。
证据级别
III 级，基于模型的经济评估。
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