Evidence map›Paper›PMID 35866194›Full record

ArticleACR open rheumatology2022

Cost-Effectiveness of Arthroscopic Partial Meniscectomy and Physical Therapy for Degenerative Meniscal Tear.

Emma E Williams, Jeffrey N Katz, Valia P Leifer, Jamie E Collins, Tuhina Neogi, Lisa G Suter, Bruce Levy, Alexander Farid, Clare E Safran-Norton, A David Paltiel and 1 more

Open access · goldAbstract read
In one paragraph

Article in ACR open rheumatology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.7field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 10 citations in OpenAlex.

  1. Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 1 country.

Emma E WilliamsBrigham and Women's Hospital, Boston, Massachusetts.ORCID https://orcid.org/0000-0003-4908-0278
Jeffrey N KatzBrigham and Women's Hospital and Harvard University, Boston, Massachusetts.
Valia P LeiferBrigham and Women's Hospital, Boston, Massachusetts.
Jamie E CollinsBrigham and Women's Hospital and Harvard University, Boston, Massachusetts.ORCID https://orcid.org/0000-0001-8413-007X
Tuhina NeogiBoston University School of Medicine, Boston, Massachusetts.ORCID https://orcid.org/0000-0002-9515-1711
Lisa G SuterYale School of Medicine, New Haven, Connecticut, and West Haven Veterans Affairs Medical Center, West Haven, Connecticut.
Bruce LevyMayo Clinic, Rochester, Minnesota.
Alexander FaridHarvard Medical School, Boston, Massachusetts.
Clare E Safran-NortonBrigham and Women's Hospital, Boston, Massachusetts.
A David PaltielYale School of Public Health, New Haven, Connecticut.
Elena LosinaBrigham and Women's Hospital, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts.ORCID https://orcid.org/0000-0002-3424-0892
Brigham and Women's Hospital · USBoston University · USHarvard University · USMayo Clinic · USVA Connecticut Research and Education Foundation · USYale New Haven Health System · US

Funding

PARTIAL MENISCECTOMY VS. NONOPERATIVE MGMT. IN MENISCAL TEAR WITH OA: AN RCTR01AR055557 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI KATZ, JEFFREY NEIL · 2007 to 2023
$11.2M
VERITY: Value and Evidence in Rheumatology using bioInformaTics, and advanced analYticsP30AR072577 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI Daniel Hal Solomon · 2017 to 2026
$9.8M
Research and Evaluation Support Core Unit (RESCU Core)P30AR072571 · NIAMS · BOSTON UNIVERSITY MEDICAL CAMPUS · PI TUHINA NEOGI · 2019 to 2026
$6.9M
Optimizing the value of pain management in knee OA patients with comorbiditiesR01AR074290 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI Elena Losina · 2018 to 2026
$5.9M
NIAMS NIH HHS P30 AR072571NIAMS NIH HHS P30 AR072577NIAMS NIH HHS R01 AR055557NIAMS NIH HHS R01 AR074290
6 · The paper itself

Abstract

objectiveWe examined the cost-effectiveness of treatment strategies for concomitant meniscal tear and knee osteoarthritis (OA) involving arthroscopic partial meniscectomy surgery and physical therapy (PT).

methodsWe used the Osteoarthritis Policy Model, a validated Monte Carlo microsimulation, to compare three strategies, 1) PT-only, 2) immediate surgery, and 3) PT + optional surgery, for participants whose pain persists following initial PT. We modeled a cohort with baseline meniscal tear, OA, and demographics from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of arthroscopic partial meniscectomy versus PT. We estimated risks and costs of arthroscopic partial meniscectomy complications and accounted for heightened OA progression post surgery using published data. We estimated surgery use rates and treatment efficacies using MeTeOR data. We considered a 5-year time horizon, discounted costs, and quality-adjusted life-years (QALYs) 3% per year and conducted sensitivity analyses. We report incremental cost-effectiveness ratios.

resultsRelative to PT-only, PT + optional surgery added 0.0651 QALY and $2,010 over 5 years (incremental cost-effectiveness ratio = $30,900 per QALY). Relative to PT + optional surgery, immediate surgery added 0.0065 QALY and $3080 (incremental cost-effectiveness ratio = $473,800 per QALY). Incremental cost-effectiveness ratios were sensitive to optional surgery efficacy in the PT + optional surgery strategy. In the probabilistic sensitivity analysis, PT + optional surgery was cost-effective in 51% of simulations at willingness-to-pay thresholds of both $50,000 per QALY and $100,000 per QALY.

conclusionFirst-line arthroscopic partial meniscectomy has a prohibitively high incremental cost-effectiveness ratio. Under base case assumptions, second-line arthroscopic partial meniscectomy offered to participants with persistent pain following initial PT is cost-effective at willingness-to-pay thresholds between $31,000 and $473,000 per QALY. Our analyses suggest that arthroscopic partial meniscectomy can be a high-value treatment option for patients with meniscal tear and OA when performed following an initial PT course and should remain a covered treatment option.

Identifiers

PMID35866194
PMCPMC9555200
OpenAlexW4286448016

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.