No differences in cost-effectiveness and short-term functional outcomes between cemented and uncemented total knee arthroplasty
BMC Musculoskeletal Disorders, vol. 21, pp. 448
Abstract
BACKGROUND: There is an ongoing debate regarding optimal fixation of total knee arthroplasty (TKA), however cost has not been addressed as profoundly. Therefore, the current study primarily aimed to compare costs and cost-effectiveness 1 year after cemented or uncemented TKA. A secondary objective was to compare short-term functional outcomes between both groups. METHODS: A posthoc prospective observational multicenter cohort study of 60 cemented and 50 uncemented Low Contact Stress (LCS) knee systems. Outcome was evaluated using the EuroQol5D-3 L (EQ5D) index, in order to calculate quality adjusted life years (QALYs). Total costs were calculated considering direct costs within the hospital setting (inpatient cost) as well as direct and indirect costs outside the hospital. Cost-effectiveness (total costs per QALY), Oxford Knee Score (OKS) and Numeric Rating Scale (NRS) were compared between cemented and uncemented cases at 1 year after surgery. HealthBASKET project, a micro-costing approach, represents the Dutch costs and situation and was used to calculate hospital stay. (In) direct costs outside the healthcare (medical cost and productivity cost) were determined using two validated questionnaires. RESULTS: Median costs per QALY were similar between cemented and uncemented TKA patients (€16,269 and €17,727 respectively; p = 0.50). Median OKS (44 and 42; p = 0.79), EQ5D (0.88 and 0.90; p = 0.82) and NRS for pain (1.0 and 1.0; p = 0.48) and satisfaction (9.0 and 9.0; p = 0.15) were also comparable between both groups. CONCLUSION: For this type of knee implant (LCS), inpatient hospital costs and costs after hospitalization were comparable between groups.
Authors 6
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Rachid Rassir corresponding
Spaarne Ziekenhuis · Spaarne Gasthuis
Affiliation as printed
Department of Orthopaedic Surgery, Spaarne Hospital, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands. rrassir@spaarnegasthuis.nl
Department of Orthopaedic Surgery, Spaarne Hospital, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands
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Affiliation as printed
Department of Orthopaedic Surgery, Spaarne Hospital, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands
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Affiliation as printed
Department of Orthopaedic Surgery, Haga Hospital, The Hague, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation as printed
Spaarne Academy, Department of Epidemiology, Spaarne Hospital, Hoofddorp, the Netherlands
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Leiden University Medical Center · Medisch Spectrum Twente
Affiliation as printed
Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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