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Cost and health status analysis after autologous chondrocyte implantation and mosaicplasty: A retrospective comparison

Published online by Cambridge University Press:  04 August 2005

Sarah Derrett ,
Elizabeth A. Stokes ,
Marilyn James ,
William Bartlett  and
George Bentley
Sarah Derrett
Affiliation:
Keele University
Elizabeth A. Stokes
Affiliation:
Keele University
Marilyn James
Affiliation:
Keele University
William Bartlett
Affiliation:
Royal National Orthopaedic Hospital
George Bentley
Affiliation:
Royal National Orthopaedic Hospital
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Abstract

Objectives: Chondral defects of the knee cartilage are prevalent. Autologous chondrocyte implantation (ACI) and mosaicplasty are increasingly used to treat symptomatic knee defects. This study assessed the costs and health status outcomes after ACI and mosaicplasty.

Methods: Patients were eligible to participate in this cross-sectional study if they received ACI or mosaicplasty at the Royal National Orthopaedic Hospital between 1997 and 2001 or were on a waiting list for ACI. Secondary-care resource use was collected to 2 years postoperatively using a resource collection proforma. Participants responded to postal questions about sociodemographic characteristics and knee-related (Modified Cincinnati Knee Rating System) and general health status (EQ-5D).

Results: Fifty-three ACI, twenty mosaicplasty, and twenty-two patients waiting for ACI participated. The average cost per patient was higher for ACI (£10,600: 95 percent confidence interval [CI], £10,036–£11,214) than mosaicplasty (£7,948: 95 percent CI, £6,957–£9,243). Postoperatively, ACI and mosaicplasty patients (combined) experienced better health status than those waiting for ACI. ACI patients tended to have better health status outcomes than mosaicplasty patients (not statistically significant). Estimated average EQ-5D social tariff improvements for quality-adjusted life year (QALY) calculations were 0.23 (ACI) and 0.06 (mosaicplasty). Average costs per QALY were £23,043 (ACI) and £66,233 (mosaicplasty). The incremental cost effectiveness ratio (ICER) for providing ACI over mosaicplasty was £16,349.

Conclusions: Average costs were higher for ACI than mosaicplasty. However, both the estimated cost per QALY and ICER for providing ACI over mosaicplasty fell beneath an implicit English funding threshold of £30,000 per QALY. Prospective studies should include measures of utility to confirm the estimated cost utility ratios of ACI and mosaicplasty.

Keywords

Autologous chondrocyteMosaicplastyCost effectivenessOutcomeKnee
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 3 , July 2005 , pp. 359 - 367
Copyright
© 2005 Cambridge University Press

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References

Barber JA, Thompson SG. 2000 Analysis of cost data in randomised trials: An application of the non-parametric bootstrap. Stat Med. 19: 3219– 3236.Google Scholar
Barber-Westin SD, Noyes FR, McCloskey JW. 1999 Rigorous statistical reliability, validity, and responsiveness testing of the Cincinnati Knee Rating System in 350 subjects with uninjured, injured, or anterior cruciate ligament-reconstructed knees. Am J Sports Med. 27: 402– 416.Google Scholar
Bentley G, Biant LC, Carrington RWJ, et al. 2003 A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 85: 223– 230.Google Scholar
Brazier JE, Harper R, Munro J, Walters SJ, Snaith ML. 1999 Generic and condition-specific outcome measures for people with osteoarthritis of the knee. Rheumatology (Oxford). 38: 870– 877.Google Scholar
Briggs AH, Wonderling DE, Mooney CZ. 1997 Pulling cost-effectiveness analysis up by its bootstraps: A non-parametric approach to confidence interval estimation. Health Econ. 6: 327– 340.Google Scholar
Briggs TWR, Mahroof S, David LA, et al. 2003 Histological evaluation of chondral defects after autologous chondrocyte implantation of the knee. J Bone Joint Surg Br. 85: 1077– 1083.Google Scholar
Brittberg M, Lindahl A, Nilsson A, et al. 1994 Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 331: 889– 895.Google Scholar
Brittberg M, Winalski CS. 2003 Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 85 (Suppl 2): 58– 69.Google Scholar
Brooks R, The EuroQol Group. 1996 EuroQol: The current state of play. Health Policy. 37: 53– 72.Google Scholar
Buckwalter JA, Mankin HJ. 1997 Articular cartilage. Part II: Degeneration and osteoarthritis repair, regeneration and transplantation. J Bone Joint Surg Am. 79: 612– 632.Google Scholar
Chang RW, Falconer J, Stulberg SD, et al. 1993 A randomised, controlled trial of arthroscopic surgery versus closed-needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum. 36: 289– 296.Google Scholar
Chibnall JT, Tait RC. 1994 The Pain Disability Index: Factor structure and normative data. Arch Phys Med Rehabil. 75: 1082– 1086.Google Scholar
Curl WW, Krome J, Gordon ES, et al. 1997 Cartilage injuries: A review of 31,516 knee arthroscopies. Arthroscopy. 13: 456– 460.Google Scholar
Dolan P, Gudex C, Kind P, Williams A. 1995. A social tariff for EuroQol: Results from a UK general population survey. Discussion Paper 138. University of York: Centre for Health Economics;
Drummond MF, O'Brien BJ, Stoddart GL, Torrance GW. 1997. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press;
Drummond MF, O'Brien BJ, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press; 1997 130– 131.
Friedman MJ, Berasi CC, Fox JM, et al. 1984 Preliminary results with abrasion arthroplasty in the osteoarthritic knee. Clin Orthop. 182: 200– 205.Google Scholar
Haddo O, Mahroof S, Higgs D, et al. 2004 The use of chondrogide membrane in autologous chondrocyte implantation. Knee. 11: 51– 55.Google Scholar
Hangody L, Feczkó P, Bartha L, Bodó G, Kish G. 2001 Mosaicplasty for the treatment of articular defects of the knee and ankle. Clin Orthop. 391 (Suppl): S328– S336.Google Scholar
Hangody L, Füles P. 2003 Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints. J Bone Joint Surg Am. 85 (Suppl 2): 25– 32.Google Scholar
Hangody L, Kish G, Kárpáti Z, et al. 1998 Mosaicplasty for the treatment of articular cartilage defects: Application in clinical practice. Orthopedics. 21: 751– 756.Google Scholar
Henderson I, Tuy B, Oakes B. 2004 Reoperation after autologous chondrocyte implantation. J Bone Joint Surg Br. 86: 205– 211.Google Scholar
Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R. 2003 Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am. 85: 185– 192.Google Scholar
Jackson RW, Marans HJ, Sliver RS. 1988 Arthroscopic treatment of degenerative arthritis of the knee. J Bone Joint Surg Br. 70: 332.Google Scholar
Jobanputra P, Parry D, Fry-Smith A, Burls A. 2001 Effectiveness of autologous chondrocyte transplantation for hyaline cartilage defects in knees: A rapid and systematic review. Health Technol Assess. 5: 1– 57.Google Scholar
King PJ, Bryant T, Minas T. 2002 Autologous chondrocyte implantations for chondral defects of the knee: Indications and technique. J Knee Surg. 15: 177– 184.Google Scholar
Knutsen G, Engebretsen L, Ludvigsen TC, et al. 2004 Autologous chondrocyte implantation compared with microfracture in the knee: A randomized trial. J Bone Joint Surg Am. 86: 455– 464.Google Scholar
Lindahl A, Brittberg M, Peterson L. 2001 Health economics benefits following autologous chondrocyte transplantation for patients with focal chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc. 9: 358– 363.Google Scholar
Micheli LJ, Browne JE, Erggelet C, et al. 2001 Autologous chondrocyte implantation of the knee: Multicenter experience and minimum 3-year follow-up. Clin J Sport Med. 11: 223– 228.Google Scholar
Minas T. 1998 Chondrocyte implantation in the repair of chondral lesions of the knee: Economics and quality of life. Am J Orthop. 11: 739– 744.Google Scholar
Minas T. 2001 Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop. 391 (Suppl): S349– S361.Google Scholar
Netten A, Curtis L. 2003 Unit costs of health and social care 2003. Canterbury: Personal Social Services Research Unit, University of Kent; 131.
Nie NH, Hull CH, Jenkins JG, Steinbrenner K, Bent DH. 1970. SPSS: Statistical package for the social sciences. New York: McGraw-Hill Book Company;
Noyes FR, Barber SD, Mooar LA. 1989 A rationale for assessing sports activity levels and limitations in knee disorders. Clin Orthop. 246: 238– 249.Google Scholar
Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A. 2002 Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med. 30: 2– 12.Google Scholar
Peterson L, Minas T, Brittberg M, Lindahl A. 2003 Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation. J Bone Joint Surg Am. 85 (Suppl 2): 17– 24.Google Scholar
Pirdie AH. 1959 The method of resurfacing osteoarthritic knees. J Bone Joint Surg Br. 41: 618– 623.Google Scholar
Pollard CA. 1984 Preliminary validity study of the Pain Disability Index. Percept Mot Skills. 59: 974.Google Scholar
Sledge SL. 2001 Microfracture techniques in the treatment of osteochondral injuries. Clin Sports Med. 20: 365– 377.Google Scholar
StataCorp. 2001. Stata statistical software: Release 7.0. College Station, TX: Stata Corporation;
Steadman JR, Rodkey WG, Briggs KK. 2002 Microfracture to treat full-thickness chondral defects: Surgical technique, rehabilitation and outcomes. J Knee Surg. 15: 170– 176.Google Scholar
Tippet JW. 1991 Articular cartilage drilling and osteotomy in osteoarthritis of the knee. In: McGinty JB, ed. Operative arthroscopy. New York: Raven Press; 325– 339.
Towse A, Pritchard C, Devlin N, eds. 2002. Cost-effectiveness thresholds: Economic and ethical issues. London: Kings Fund and Office of Health Economics (UK);
World Health Organisation. 1993. Proceedings of the 2nd International Consultation on Benign Prostatic Hyperplasia (BPH). Paris: World Health Organisation;