Costs of surgical vs. conservative treatment of knee OA

...which one is most cost-effective?

Knee osteoarthritis (OA) is one of the most widespread and costly burdens of disease globally, as it severely limits function and causes pain.

The estimated cost of treating knee OA is €817 billion Euro per year, but this is expected to increase.

This randomised controlled trial (RCT) compared the cost-effectiveness of undergoing a total knee preplacement (TKR) followed by twelve weeks of supervised therapy, with twelve weeks of supervised therapy only with the option of surgery at a later time if necessary.

At 12 months, the costs in the TKR plus non-surgical treatment group were more than double of those in the non-surgical group.

However, 24 months the costs of the TKR plus non-surgical treatment were not significantly different from the non-surgical group. This is due to several of the patients in the non-surgical group who underwent TKR at a later time - 1 in 3 in the non-surgical group went on to have a TKR in the next two years.

Although TKR plus non-surgical treatment seemed to be more effective, it was not more cost-effective than non-surgical treatment with the option of surgery at a later time. 

Finally, as results were sensitive for adjustment for covariates and imputation of missing values, more research with longer periods of follow-up is necessary.

> From: Skou et al., BMJ Open 10 (2020) e033495 . All rights reserved to The Author(s). Click here for the online summary.

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