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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, 27 . pp. 1739-1753. doi:10.1007/s00167-019-05392-8 ISSN 0942-2056.

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Official URL: http://dx.doi.org/10.1007/s00167-019-05392-8

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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
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
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: 1 June 2019
Dates:
DateEvent
1 June 2019Published
5 February 2019Available
30 January 2019Accepted
Volume: 27
Page Range: pp. 1739-1753
DOI: 10.1007/s00167-019-05392-8
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 11 February 2019
Date of first compliant Open Access: 12 February 2019
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDEuropean Society of Sports Traumatology, Knee Surgery and Arthroscopyhttp://viaf.org/viaf/134546733

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