Cost-effectiveness analysis of Coblation versus mechanical shaver debridement in patients following knee chondroplasty

Cost Effectiveness and Resource Allocation

Anil Ranawat¹  Ayoade Adeyemi²  Paul Trueman³  Leo Nherera⁴ 

[1] Department of Sports, Hospital for Special Surgery, New York, NY, USA;Smith & Nephew, Inc, Andover, MA, USA;Smith & Nephew, Inc, Hull, UK;Smith & Nephew, Inc, Hull, UK;Smith & Nephew Inc, 5600 Clearfork Main Street, 76109, Fort Worth, TX, USA;

关键词: Coblation;    Chondroplasty;    Mechanical shaver debridement;    Cost-effectiveness;    Revision rates;    Cartilage lesions;   

DOI  :  10.1186/s12962-020-00240-w

来源: Springer

【 摘 要 】

BackgroundTo compare costs and outcomes following knee chondroplasty with Coblation versus mechanical shaver debridement (MSD) in patients with grade III articular cartilage lesions of the knee.MethodsA decision-analytic model was developed to compare costs and outcomes of the two methods from a US payer perspective. We used published clinical data from a single-center randomized clinical trial (RCT) designed to compare outcomes between Coblation and MSD in patients with grade III articular cartilage lesions of the medial femoral condyle. Following primary knee chondroplasty, patients experienced either treatment success (no additional surgery required) or required a revision over the 4 year follow-up period. Costs associated with the initial chondroplasty, physical therapy sessions through the 6 week postoperative period, and revision rates at 4 years post-surgery were estimated using 2018 US Medicare Physician Fee Schedule. Sensitivity analyses including a 10 year time horizon and threshold analyses were performed to test the robustness of the model.ResultsThe estimated total cost per patient was $4614 and $7886 for Coblation and MSD, respectively, resulting in cost-savings of $3272 in favor of Coblation, making it a dominant strategy because of lower costs and improved clinical outcomes. Threshold analysis showed that Coblation remained dominant even when revision rates were assumed to increase from the base case rate of 14–66%. Sensitivity analyses showed that cost-saving results were insensitive to variations in revision rates, number of physical therapy sessions and the time horizon used.ConclusionCoblation chondroplasty is a cost-saving procedure compared with MSD in the treatment of patients with grade III articular cartilage lesions of the knee.

【 授权许可】

CC BY