A Treatment for Osteoarthritis is ‘Very Cost-effective’ in Older Adults
A new study finds that picking up the tab for total knee replacements in Medicare enrollees is money well spent.
The new analysis, which was published in the June 22, 2009 issue of the Archives of Internal Medicine, is the first to look at the cost-effectiveness of total knee arthroplasty, a surgical procedure that is rapidly rising in popularity as Americans age and become more obese. In 2006, for example 500,000 total knee replacements were performed in the U. S., but that figure is expected to balloon to 3.5 million by the year 2030.
As legislators sit down to rethink the way health care is delivered in America, expect to hear a lot more about cost-effectiveness, which is a way to compare the value, in terms of quality of life and added life expectancy, of medical procedures and treatments.
“We can compare interventions across different conditions,” explained Elena Losina, PhD, of the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston, who was the lead author on the study. Dr. Losina’s work was supported, in part, by an Arthritis Investigator Award from the Arthritis Foundation.
The average price of a total knee replacement in the current study was nearly $21,000, but participants who underwent the surgery achieved a significantly better quality of life and could expect to live about a year longer than adults over age 65 who managed their osteoarthritis with medical treatments alone. That brought the average cost-effectiveness ratio to $18,300 per quality-adjusted life-year gained by performing the surgery. For high-risk patients in the study, the cost-effectiveness ratio was slightly higher at $28,000 per quality-adjusted life-year gained.
Dr. Losina said that there is significant debate about what threshold to use to determine when a procedure is simply too expensive for the benefit it provides.
The World Health Organization has suggested that a procedure is cost-effective if it is less than three times the per capita gross domestic product, or GDP, of a given country. An intervention is considered to be highly cost-effective if it is less than one times the per GDP. In the United States, the per capita GDP is about $45,000.
“So no matter which threshold you’re using, it’s a very cost effective procedure,” Dr. Losina said.
Read the other articles in the July/August issue of Research Update: