Forecasting the value of innovation in total knee arthroplasty care: A headroom approach

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-12-18 DOI:10.1002/jeo2.70096

Thomas M. Otten, Sabine E. Grimm, Bram Ramaekers, Alex Roth, Pieter Emans, Tim Boymans, Maarten Janssen, Ralph Jeuken, Manuela A. Joore

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Abstract

Purpose

Total knee arthroplasty (TKA) is the standard treatment of end-stage osteoarthritis. TKA is often used and, therefore, poses a healthcare and societal burden, which is likely to increase further. Headroom analyses evaluate a technology under development by making assumptions about its effectiveness. This article applies a headroom approach to forecast the potential value of innovations that improve TKA-related care in the Netherlands in terms of cost-effectiveness and surgeries avoided.

Methods

A state-transition model estimating lifetime direct health effects, healthcare- and societal costs and percentage of avoide d surgeries was developed. The model compared care as usual to five hypothetical interventions to calculate the headroom associated with (1) preventing the need for TKAs, (2) preventing the need for all TKA revisions, (3) postponing TKAs without quality-of-life loss, (4) preventing periprosthetic joint infections (PJIs) and (5) improving patient satisfaction.

Results

Preventing the need for all TKAs amounted to €43,076 of headroom. Preventing the need for TKA revisions amounted to €2276 (5.8% of surgeries avoided), postponing TKAs by 5 years amounted to €7634 (32.4% of surgeries avoided), preventing PJIs amounted to €1187 (1.4% of surgeries avoided) and improving patient satisfaction amounted to €16,622 (0% of surgeries avoided). The headroom of each hypothetical intervention was highest in younger populations (<50 years of age).

Conclusion

There is a headroom for improving TKA-related care. Innovations to avoid or postpone TKA (i.e., joint-preserving treatments) as well as those that improve patient satisfaction can be effective in maximizing the value for money and avoiding surgeries. Due to the decreasing average patient age, innovations to reduce revision rates and PJIs will become more valuable as these are most effective in younger patients. It is currently unclear how cost-effectiveness considerations should be traded off against the prevention of surgery to reduce the increasing burden on the healthcare system.

Level of Evidence

Level III economic evaluation/decision-analytic model.

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预测全膝关节置换术护理创新的价值：一种净空方法。

目的：全膝关节置换术是治疗终末期骨关节炎的标准方法。TKA经常被使用，因此造成了医疗保健和社会负担，这种负担可能会进一步增加。净空分析通过对一项正在开发的技术的有效性做出假设来评估该技术。这篇文章应用一个净空的方法来预测创新的潜在价值，提高tka相关的护理在荷兰的成本效益和手术避免方面。方法：建立了一个状态转换模型，估计终生直接健康影响、医疗保健和社会成本以及避免手术的百分比。该模型将常规护理与五种假设干预措施进行比较，以计算以下方面相关的剩余空间：(1)防止TKA的需要，(2)防止所有TKA修改的需要，(3)在不影响生活质量的情况下推迟TKA，(4)防止假体周围关节感染（PJIs）和(5)提高患者满意度。结果：预防所有tka所需的净空量为43,076欧元。预防TKA修订的需要达2276欧元（避免手术的5.8%），推迟TKA 5年达7634欧元（避免手术的32.4%），预防pji达1187欧元（避免手术的1.4%），提高患者满意度达16,622欧元（避免手术的0%）。在年轻人群中，每种假设干预的净空空间最高(结论：tka相关护理的改善仍有净空空间。避免或推迟TKA（即关节保留治疗）的创新以及提高患者满意度的创新可以有效地最大化物有所值并避免手术。由于患者平均年龄的下降，降低翻修率和pji的创新将变得更有价值，因为它们在年轻患者中最有效。目前尚不清楚如何权衡成本效益与预防手术之间的关系，以减轻医疗保健系统日益增加的负担。证据等级：三级经济评价/决策分析模型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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