Modelling the cost-effectiveness of total knee arthroplasty: A systematic review.

Objective: Osteoarthritis causes a significant healthcare burden and the number of total knee arthroplasty (TKA) procedures is predicted to increase significantly in the coming years. We conducted a systematic review to assess the scope and quality of all current TKA cost-effectiveness analysis (CEA) studies, identify trends, and identify areas for improvement. Methods: An electronic database search of MEDLINE, Embase, the CEA registry and Scopus was used to identify all CEA studies where TKA was used with a comparator. Studies were included from January 1, 1997 to February 2, 2020. The Quality of Health Economic Analysis Studies (QHES) instrument was used to assess their quality. Thirty-three studies were included that offered both a QALY and cost calculation. The main findings, incremental-cost effectiveness ratios and other important study characteristics were then ascertained, and trends identified. Results: Certain surgical interventions were suggested to be more cost-effective than TKA. This included unicompartmental knee arthroplasty for unicompartmental osteoarthritis, computer-assisted TKA compared to conventional TKA, and resurfacing the patella compared to no resurfacing. TKA was more cost-effective compared to non-operative management regardless of specific patient variables. Conclusions: The analyses of the CEAs included in the study have to be interpreted with caution. Overall, certain surgical methods within TKA and alternative methods to TKA appear to be favoured for treating particular knee osteoarthritic conditions due to their suggested greater cost-effectiveness but this should be interpreted within local contexts. Our results should help guide future policy-making as healthcare associated costs continue to rise.