Tobias Vogelmann1, Philip P Roessler2, Matthias Buhs3, Sven Ostermeier4, Justus Gille5, Arnd Hoburg6, York Zöllner7, Sebastian Schwarz8, Tino Schubert9, Marco Grebe8, Wolfgang Zinser10. 1. LinkCare GmbH, Kyffhäuserstr. 64, 70469, Stuttgart, Germany. tv@link-care.de. 2. Gelenkzentrum Mittelrhein GmbH, Mayen, Germany. 3. Norddeutsches Knorpelcentrum, Quickborn, Germany. 4. MVZ Gelenk-Klinik, Gundelfingen, Germany. 5. University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. 6. Med Center 360°, Berlin, Germany. 7. Hamburg University of Applied Sciences, Hamburg, Germany. 8. CO.DON AG, Leipzig, Germany. 9. LinkCare GmbH, Kyffhäuserstr. 64, 70469, Stuttgart, Germany. 10. OrthoExpert Fohnsdorf, Austria and GFO-Kliniken Niederrhein, Dinslaken, Germany.
Abstract
INTRODUCTION: Cartilage defects in the knee can be caused by injury, various types of arthritis, or degeneration. As a long-term consequence of cartilage defects, osteoarthritis can develop over time, often leading to the need for a total knee replacement (TKR). The treatment alternatives of chondral defects include, among others, microfracture, and matrix-associated autologous chondrocyte implantation (M-ACI). The purpose of this study was to determine cost-effectiveness of M-ACI in Germany with available mid- and long-term outcome data, with special focus on the avoidance of TKR. MATERIALS AND METHODS: We developed a discrete-event simulation (DES) that follows up individuals with cartilage defects of the knee over their lifetimes. The DES was conducted with a status-quo scenario in which M-ACI is available and a comparison scenario with no M-ACI available. The model included 10,000 patients with articular cartilage defects. We assumed Weibull distributions for short- and long-term effects for implant failures. Model outcomes were costs, number of TKRs, and quality-adjusted life years (QALYs). All analyses were performed from the perspective of the German statutory health insurance. RESULTS: The majority of patients was under 45 years old, with defect sizes between 2 and 7 cm2 (mean: 4.5 cm2); average modeled lifetime was 48 years. In the scenario without M-ACI, 26.4% of patients required a TKR over their lifetime. In the M-ACI scenario, this was the case in only 5.5% of cases. Thus, in the modeled cohort of 10,000 patients, 2700 TKRs, including revisions, could be avoided. Patients treated with M-ACI experienced improved quality of life (22.53 vs. 21.21 QALYs) at higher treatment-related costs (18,589 vs. 14,134 € /patient) compared to those treated without M-ACI, yielding an incremental cost-effectiveness ratio (ICER) of 3376 € /QALY. CONCLUSION: M-ACI is projected to be a highly cost-effective treatment for chondral defects of the knee in the German healthcare setting.
INTRODUCTION: Cartilage defects in the knee can be caused by injury, various types of arthritis, or degeneration. As a long-term consequence of cartilage defects, osteoarthritis can develop over time, often leading to the need for a total knee replacement (TKR). The treatment alternatives of chondral defects include, among others, microfracture, and matrix-associated autologous chondrocyte implantation (M-ACI). The purpose of this study was to determine cost-effectiveness of M-ACI in Germany with available mid- and long-term outcome data, with special focus on the avoidance of TKR. MATERIALS AND METHODS: We developed a discrete-event simulation (DES) that follows up individuals with cartilage defects of the knee over their lifetimes. The DES was conducted with a status-quo scenario in which M-ACI is available and a comparison scenario with no M-ACI available. The model included 10,000 patients with articular cartilage defects. We assumed Weibull distributions for short- and long-term effects for implant failures. Model outcomes were costs, number of TKRs, and quality-adjusted life years (QALYs). All analyses were performed from the perspective of the German statutory health insurance. RESULTS: The majority of patients was under 45 years old, with defect sizes between 2 and 7 cm2 (mean: 4.5 cm2); average modeled lifetime was 48 years. In the scenario without M-ACI, 26.4% of patients required a TKR over their lifetime. In the M-ACI scenario, this was the case in only 5.5% of cases. Thus, in the modeled cohort of 10,000 patients, 2700 TKRs, including revisions, could be avoided. Patients treated with M-ACI experienced improved quality of life (22.53 vs. 21.21 QALYs) at higher treatment-related costs (18,589 vs. 14,134 € /patient) compared to those treated without M-ACI, yielding an incremental cost-effectiveness ratio (ICER) of 3376 € /QALY. CONCLUSION: M-ACI is projected to be a highly cost-effective treatment for chondral defects of the knee in the German healthcare setting.
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Authors: P Niemeyer; D Albrecht; S Andereya; P Angele; A Ateschrang; M Aurich; M Baumann; U Bosch; C Erggelet; S Fickert; H Gebhard; K Gelse; D Günther; A Hoburg; P Kasten; T Kolombe; H Madry; S Marlovits; N M Meenen; P E Müller; U Nöth; J P Petersen; M Pietschmann; W Richter; B Rolauffs; K Rhunau; B Schewe; A Steinert; M R Steinwachs; G H Welsch; W Zinser; J Fritz Journal: Knee Date: 2016-03-03 Impact factor: 2.199
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