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Study Shows Value of TKR in Virtually All Patients

BOSTON, MA -- November 9, 2007 -- Total knee replacement is cost effective for the treatment of end-stage arthritis, even when treating high-risk patients, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.

When the knee is severely damaged by advanced arthritis and other treatment is not effective, total knee replacement may become an option. TKR removes worn cartilage and bone and resurfaces the knee with materials that function much like a normal joint.

By developing a computer simulation model of treatment options, researchers weighed the costs of living with end stage arthritis and the costs of TKR against the potential improvements in both quantity and quality of life resulting from the procedure. This provided them with an estimate of the net cost per extra quality adjusted year of life gained (cost-effectiveness) from TKR.

Researchers found that TKR can increase quality-adjusted life expectancy by two-and-a-half quality-adjusted life years (which take into account both the quality and quantity of years lived). In the absence of TKR, lifetime costs averaged $29,000 for patients with end-stage knee arthritis. For patients undergoing TKR, lifetime costs increased to $41,500, resulting in cost-effectiveness ratio of $5,300/QALY. Even for patients with multiple medical problems, 'high risk' TKR resulted in additional 2.1 quality-adjusted years, with the cost-effectiveness of $7,000 per quality adjusted year gained. There was substantial QALY gain in both high and low volume surgery centers.

Researchers explain that cost-effectiveness is a very different concept from cost-saving. Patients spend more money for TKR, but are doing more than finding a temporary fix -- they are improving their quality of life, which goes beyond the price of surgery.

"We found that TKR represents an effective and very cost-effective option for all patients with knee arthritis, not just those whom we might label 'ideal' candidates," said Elena Losina, PhD, lead author of the study. "While it has been shown that higher volume facilities deliver better outcomes at lower cost, we would like to stress that TKR remains an attractive treatment option even in lower-volume settings. TKR delivers better value than many other widely accepted musculoskeletal procedures, such as lumbar discectomy and fusion of the spine for spondylolisthesis."


SOURCE: American College of Rheumatology

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