Cost-effectiveness of arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in patients aged under 45 years.
Journal
The bone & joint journal
ISSN: 2049-4408
Titre abrégé: Bone Joint J
Pays: England
ID NLM: 101599229
Informations de publication
Date de publication:
01 Nov 2023
01 Nov 2023
Historique:
medline:
2
11
2023
pubmed:
1
11
2023
entrez:
1
11
2023
Statut:
epublish
Résumé
The aim of this study was to evaluate the cost-effectiveness of arthroscopic partial meniscectomy versus physical therapy plus optional delayed arthroscopic partial meniscectomy in young patients aged under 45 years with traumatic meniscal tears. We conducted a multicentre, open-labelled, randomized controlled trial in patients aged 18 to 45 years, with a recent onset, traumatic, MRI-verified, isolated meniscal tear without knee osteoarthritis. Patients were randomized to arthroscopic partial meniscectomy or standardized physical therapy with an optional delayed arthroscopic partial meniscectomy after three months of follow-up. We performed a cost-utility analysis on the randomization groups to compare both treatments over a 24-month follow-up period. Cost utility was calculated as incremental costs per quality-adjusted life year (QALY) gained of arthroscopic partial meniscectomy compared to physical therapy. Calculations were performed from a healthcare system perspective and a societal perspective. A total of 100 patients were included: 49 were randomized to arthroscopic partial meniscectomy and 51 to physical therapy. In the physical therapy group, 21 patients (41%) received delayed arthroscopic partial meniscectomy during follow-up. Over 24 months, patients in the arthroscopic partial meniscectomy group had a mean 0.005 QALYs lower quality of life (95% confidence interval -0.13 to 0.14). The cost-utility ratio was €-160,000/QALY from the healthcare perspective and €-223,372/QALY from the societal perspective, indicating that arthroscopic partial meniscectomy incurs additional costs without any added health benefit. Arthroscopic partial meniscectomy is arthroscopic partial meniscectomy is unlikely to be cost-effective in treating young patients with isolated traumatic meniscal tears compared to physical therapy as a primary health intervention. Arthroscopic partial meniscectomy leads to a similar quality of life, but higher costs, compared to physical therapy plus optional delayed arthroscopic partial meniscectomy.
Identifiants
pubmed: 37909164
doi: 10.1302/0301-620X.105B11.BJJ-2023-0107.R1
pii: BJJ-2023-0107.R1
doi:
Types de publication
Randomized Controlled Trial
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1177-1183Informations de copyright
© 2023 van der Graaff et al.
Déclaration de conflit d'intérêts
D. E. Meuffels and M. A. Koopmanschap report an institutional grant from Zon MW, paid to Erasmus MC, related to this study.
Références
Poehling GG , Ruch DS , Chabon SJ . The landscape of meniscal injuries . Clin Sports Med . 1990 ; 9 ( 3 ): 539 – 549 . 2379242
Lohmander LS , Englund PM , Dahl LL , Roos EM . The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis . Am J Sports Med . 2007 ; 35 ( 10 ): 1756 – 1769 . 10.1177/0363546507307396 17761605
Poulsen E , Goncalves GH , Bricca A , Roos EM , Thorlund JB , Juhl CB . Knee osteoarthritis risk is increased 4-6 fold after knee injury - a systematic review and meta-analysis . Br J Sports Med . 2019 ; 53 ( 23 ): 1454 – 1463 . 10.1136/bjsports-2018-100022 31072840
Menon J , Mishra P . Health care resource use, health care expenditures and absenteeism costs associated with osteoarthritis in US healthcare system . Osteoarthritis Cartilage . 2018 ; 26 ( 4 ): 480 – 484 . 10.1016/j.joca.2017.12.007 29269328
No authors listed . Artroscopie van de knie . Nederlandse Orthopaedische Vereniging . 2019 . https://richtlijnendatabase.nl/richtlijn/artroscopie_van_de_knie/startpagina_-_artroscopie_van_de_knie.html ( date last accessed 20 September 2023 ).
Kopf S , Beaufils P , Hirschmann MT , et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus . Knee Surg Sports Traumatol Arthrosc . 2020 ; 28 ( 4 ): 1177 – 1194 . 10.1007/s00167-020-05847-3 32052121
Logerstedt DS , Scalzitti DA , Bennell KL , et al. Knee pain and mobility impairments: meniscal and articular cartilage lesions revision 2018 . J Orthop Sports Phys Ther . 2018 ; 48 ( 2 ): A1 – A50 . 10.2519/jospt.2018.0301 29385940
Abram SGF , Judge A , Beard DJ , Price AJ . Adverse outcomes after arthroscopic partial meniscectomy: a study of 700 000 procedures in the national Hospital Episode Statistics database for England . Lancet . 2018 ; 392 ( 10160 ): 2194 – 2202 . 10.1016/S0140-6736(18)31771-9 30262336
Thorlund JB , Juhl CB , Roos EM , Lohmander LS . Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms . BMJ . 2015 ; 350 : h2747 . 10.1136/bmj.h2747 26080045
Nwachukwu BU , Schairer WW , Bernstein JL , Dodwell ER , Marx RG , Allen AA . Cost-effectiveness analyses in orthopaedic sports medicine: a systematic review . Am J Sports Med . 2015 ; 43 ( 6 ): 1530 – 1537 . 10.1177/0363546514544684 25125693
Rongen JJ , Govers TM , Buma P , Rovers MM , Hannink G . Arthroscopic meniscectomy for degenerative meniscal tears reduces knee pain but is not cost-effective in a routine health care setting: a multi-center longitudinal observational study using data from the osteoarthritis initiative . Osteoarthritis Cartilage . 2018 ; 26 ( 2 ): 184 – 194 . 10.1016/j.joca.2017.02.805 28903016
van de Graaf VA , van Dongen JM , Willigenburg NW , et al. How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study . Br J Sports Med . 2020 ; 54 ( 9 ): 538 – 545 . 10.1136/bjsports-2018-100065 31227493
van der Graaff SJA , Eijgenraam SM , Meuffels DE , et al. Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial . Br J Sports Med . 2022 ; 56 ( 15 ): 870 – 876 . 10.1136/bjsports-2021-105059 35676079
Van Arkel ERA , Koëter S , Rijk PC , et al. Dutch Guideline on Knee Arthroscopy Part 1, the meniscus: a multidisciplinary review by the Dutch Orthopaedic Association . Acta Orthop . 2021 ; 92 ( 1 ): 74 – 80 . 10.1080/17453674.2020.1850086 33228479
Kellgren JH , Lawrence JS . Radiological assessment of osteo-arthrosis . Ann Rheum Dis . 1957 ; 16 ( 4 ): 494 – 502 . 10.1136/ard.16.4.494 13498604
No authors listed . Richtlijn Artroscopie van de Knie: Indicatie en Behandeling . Nederlandse Orthopaedische Vereniging . 2010 . http://www.med-info.nl/Richtlijnen/Bewegingsapparaat/Artroscopie%20knie.pdf ( date last accessed 20 September 2023 ).
Lamers LM , McDonnell J , Stalmeier PFM , Krabbe PFM , Busschbach JJV . The Dutch tariff: results and arguments for an effective design for national EQ-5D valuation studies . Health Econ . 2006 ; 15 ( 10 ): 1121 – 1132 . 10.1002/hec.1124 16786549
Bouwmans C , Hakkaart-van Roijen L , Koopmanschap M , et al. Medical Consumption Questionnaire . Productivity and Health Research Group . 2013 . https://docplayer.nl/60086739-Medical-consumption-questionnaire-productivity-and-health-research-group.html ( date last accessed 20 September 2023 ).
No authors listed . Healthcare Institute of the Netherlands . https://www.medicijnkosten.nl/ ( date last accessed 20 September 2023 ).
Hakkaart-Van Roijen LLN , Bouwmans CA , Kanters T . Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg . 2015 . https://docplayer.nl/12082781-Kostenhandleiding-methodologie-van-kostenonderzoek-en-referentieprijzen-voor-economische-evaluaties-in-de-gezondheidszorg.html ( date last accessed 20 September 2023 ).
Bouwmans C , Krol M , Severens H , Koopmanschap M , Brouwer W , Hakkaart-van Roijen L . The iMTA Productivity Cost Questionnaire: a standardized instrument for measuring and valuing health-related productivity losses . Value Health . 2015 ; 18 ( 6 ): 753 – 758 . 10.1016/j.jval.2015.05.009 26409601
Koopmanschap MA , Rutten FF , van Ineveld BM , van Roijen L . The friction cost method for measuring indirect costs of disease . J Health Econ . 1995 ; 14 ( 2 ): 171 – 189 . 10.1016/0167-6296(94)00044-5 10154656
Eggerding V , Reijman M , Meuffels DE , et al. ACL reconstruction for all is not cost-effective after acute ACL rupture . Br J Sports Med . 2022 ; 56 ( 1 ): 24 – 28 . 10.1136/bjsports-2020-102564 33737313
Tan SS , Teirlinck CH , Dekker J , et al. Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care . Osteoarthritis Cartilage . 2016 ; 24 ( 4 ): 581 – 588 . 10.1016/j.joca.2015.11.010 26620092
Hermans J , Reijman M , Goossens LMA , Verburg H , Bierma-Zeinstra SMA , Koopmanschap MA . Cost-utility analysis of high molecular weight hyaluronic acid for knee osteoarthritis in everyday clinical care in patients at a working age: An economic evaluation of a randomized clinical trial . Arthritis Care Res (Hoboken) . 2018 ; 70 ( 1 ): 89 – 97 . 10.1002/acr.23242 28320075
Janssen MF , Szende A , Cabases J , Ramos-Goñi JM , Vilagut G , König HH . Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries . Eur J Health Econ . 2019 ; 20 ( 2 ): 205 – 216 . 10.1007/s10198-018-0955-5 29445941
Pickard AS , Neary MP , Cella D . Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer . Health Qual Life Outcomes . 2007 ; 5 : 70 . 10.1186/1477-7525-5-70 18154669
Walters SJ , Brazier JE . Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D . Qual Life Res . 2005 ; 14 ( 6 ): 1523 – 1532 . 10.1007/s11136-004-7713-0 16110932
van de Graaf VA , Wolterbeek N , Scholtes VAB , Mutsaerts E , Poolman RW . Reliability and validity of the IKDC, KOOS, and WOMAC for patients with meniscal injuries . Am J Sports Med . 2014 ; 42 ( 6 ): 1408 – 1416 . 10.1177/0363546514524698 24618098
M Versteegh M , M Vermeulen K , M A A Evers S , de Wit GA , Prenger R , A Stolk E . Dutch tariff for the five-level version of EQ-5D . Value Health . 2016 ; 19 ( 4 ): 343 – 352 . 10.1016/j.jval.2016.01.003 27325326