Costs and models used in the economic analysis of Total Knee Replacement (TKR): A Systematic Review

Abstract

AbstractObjectivesThe major objective of this review was to summarize the evidence on the core modelling specifications and procedures on the cost-effectiveness of TKR compared to non-surgical management. Another objective of this study was to synthesize evidence of TKR cost and compare it across countries using purchasing power parity (PPP).MethodologyThe electronic databases used were MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), HTAIn repository and Cost effectiveness Analysis (CEA) registry. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the validity of the methods and transparency in reporting the results of the included studies. The cost of TKR surgery from high income and low-or middle-income countries were extracted and converted to single USD ($) using purchasing power parities (PPP) method.Result29 studies were included in this review, out of which eight studies used Markov model, five studies used regression model, one study each reported Marginal structure model and discrete simulation model and decision tree analysis to assess cost-effectiveness of TKR. For PPP, 23 studies were included in the analysis of TKR cost. The average cost of TKR surgery was lowest in developing country like India ($3457) and highest in USA ($19,645).ConclusionThe findings of this review showed that the Markov model was most widely used in the analysis of the cost effectiveness of TKR. Our review also concluded that the cost of TKR was higher in developed countries as compared to developing countries.