Research In Brief

Knee arthroplasty is worth it: Total knee replacement surgery is generally cost-effective, according to a study in the June 22 issue of the Archives of Internal Medicine. The authors, from several Boston hospitals, Boston University, Harvard, Yale and the University of California, calculated the cost per quality-adjusted life-year from knee replacement to be $18,300 compared to non-surgical management; in a predefined high-risk group the ratio increased to $28,100, but both numbers fall below typical cost-effectiveness thresholds, the researchers say. Costs were comparatively higher at low-volume facilities, the paper pointed out. The data was derived from a computer simulation model populated with cost and outcomes data on knee osteoarthritis patients from Medicare claims and other sources. An accompanying editorial in the journal touts the results as important, but also says the study illustrates the challenges of technology assessments and comparative effectiveness research. The cost-effectiveness ratio is very sensitive to the outcomes denominator, but because there are no gold standard randomized trials comparing knee replacement and medical management, the precise accuracy of the data is in question, the editorial points out