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The cost-effectiveness of osteochondral allograft transplantation in the knee
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Mistry, Hema, Metcalfe, Andrew J., Smith, Nick, Loveman, Emma, Colquitt, Jill, Royle, Pamela and Waugh, Norman (2019) The cost-effectiveness of osteochondral allograft transplantation in the knee. Knee Surgery, Sports Traumatology, Arthroscopy . doi:10.1007/s00167-019-05392-8 (In Press)
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Official URL: http://dx.doi.org/10.1007/s00167-019-05392-8
Abstract
Purpose
Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. They are used to repair combined defects of articular cartilage and bone. Such defects often occur in people far too young to have knee arthroplasty, for whom the main alternative to OCA is conservative symptomatic care, which will not prevent development of osteoarthritis. The aim of this report was to assess the cost-effectiveness of osteochondral allograft transplantation in the knee.
Methods
Systematic review of evidence on clinical effectiveness and economic modelling.
Results
The evidence on osteochondral allograft transplantation comes from observational studies, but often based on good quality prospective registries of all patients having such surgery. Without controlled trials, it was necessary to use historical cohorts to assess the effect of osteochondral grafts. There is good evidence that OCA are clinically effective with a high graft survival rate over 20 years. If an OCA graft fails, there is some evidence that revision with a second OCA is also effective, though less so than primary OCA. Economic modelling showed that osteochondral allograft transplantation was highly cost-effective, with costs per quality adjusted life year much lower than many other treatments considered cost effective.
Conclusions
Osteochondral allograft transplantation appears highly cost-effective though the cost per quality adjusted life year varies according to the widely varying costs of allografts. Based on one small study, revision OCA also appears very cost-effective, but more evidence is needed.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RD Surgery | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Homografts -- Cost effectiveness, Knee -- Diseases | ||||||||
| Journal or Publication Title: | Knee Surgery, Sports Traumatology, Arthroscopy | ||||||||
| Publisher: | Springer | ||||||||
| ISSN: | 0942-2056 | ||||||||
| Official Date: | 2019 | ||||||||
| Dates: |
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| Date of first compliant deposit: | 11 February 2019 | ||||||||
| DOI: | 10.1007/s00167-019-05392-8 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | In Press | ||||||||
| Access rights to Published version: | Open Access | ||||||||
| RIOXX Funder/Project Grant: |
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