Evidence map›Paper›PMID 36250415›Full record

ArticleArthritis care & research2023

Cost-Effectiveness of Weight-Loss Interventions Prior to Total Knee Replacement for Patients With Class III Obesity.

Aleksandra M Kostic, Valia P Leifer, Faith Selzer, David J Hunter, A David Paltiel, Antonia F Chen, Malcolm K Robinson, Tuhina Neogi, Jamie E Collins, Stephen P Messier and 3 more

Open access · greenAbstract read
In one paragraph

Article in Arthritis care & research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 2 pooled it
1.5field-weighted citation impact, top 17% 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

5 citing papers in PubMed, 2 syntheses or guidelines pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Article
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

13 authors at 5 institutions in 2 countries.

Aleksandra M KosticBrigham and Women's Hospital, Boston, Massachusetts.
Valia P LeiferBrigham and Women's Hospital, Boston, Massachusetts.
Faith SelzerBrigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
David J HunterUniversity of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia.ORCID 0000-0003-3197-752X
A David PaltielYale School of Public Health, New Haven, Connecticut.
Antonia F ChenBrigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Malcolm K RobinsonBrigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Tuhina NeogiBoston University School of Medicine, Boston, Massachusetts.ORCID 0000-0002-9515-1711
Jamie E CollinsBrigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.ORCID 0000-0001-8413-007X
Stephen P MessierWake Forest University, Salem, North Carolina.ORCID 0000-0002-7033-8459
Robert R EdwardsBrigham and Women's Hospital, Boston, Massachusetts.
Jeffrey N KatzBrigham and Women's Hospital, Harvard Medical School, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts.ORCID 0000-0003-2104-4670
Elena LosinaBrigham and Women's Hospital, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts.ORCID 0000-0002-3424-0892
Brigham and Women's Hospital · USBoston University · USThe University of Sydney · AUWake Forest University · USYale New Haven Health System · US

Funding

VERITY: Value and Evidence in Rheumatology using bioInformaTics, and advanced analYticsP30AR072577 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI Elena Losina · 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
The Role of Urate in Knee Osteoarthritis-Related Inflammation, Pathology and PainK24AR070892 · NIAMS · BOSTON UNIVERSITY MEDICAL CAMPUS · PI TUHINA NEOGI · 2017 to 2026
$1.1M
NIAMS NIH HHS K24 AR070892NIAMS NIH HHS P30 AR072571NIAMS NIH HHS P30 AR072577NIAMS NIH HHS R01 AR074290
6 · The paper itself

Abstract

objectiveClass III obesity (body mass index >40 kg/m

methodsUsing the Osteoarthritis Policy model and data from published literature to derive model inputs for RYGB, LSG, LNSWL, and TKR, we assessed the long-term clinical benefits, costs, and cost-effectiveness of weight-loss interventions for patients with class III obesity considering TKR. We assessed the following strategies with a health care sector perspective: 1) no weight loss/no TKR, 2) immediate TKR, 3) LNSWL, 4) LSG, and 5) RYGB. Each weight-loss strategy was followed by annual TKR reevaluation. Primary outcomes were cost, quality-adjusted life expectancy (QALE), and incremental cost-effectiveness ratios (ICERs), discounted at 3% per year. We conducted deterministic and probabilistic sensitivity analyses to examine the robustness of conclusions to input uncertainty.

resultsLSG increased QALE by 1.64 quality-adjusted life-years (QALYs) and lifetime medical costs by $17,347 compared to no intervention, leading to an ICER of $10,600/QALY. RYGB increased QALE by 0.22 and costs by $4,607 beyond LSG, resulting in an ICER of $20,500/QALY. Relative to immediate TKR, LSG and RYGB delayed and decreased TKR utilization. In the probabilistic sensitivity analysis, RYGB was cost-effective in 67% of iterations at a willingness-to-pay threshold of $50,000/QALY.

conclusionFor patients with class III obesity considering TKR, RYGB provides good value while immediate TKR without weight loss is not economically efficient.

Indexed as

Arthroplasty, Replacement, KneeGastric BypassObesity, MorbidOsteoarthritis, KneeCost-Benefit AnalysisGastrectomyHumansObesityWeight Loss

Identifiers

PMID36250415
PMCPMC10375659
OpenAlexW4306403140

What OpenQuestion holds

Textmetadata
LicenceTDM
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.