Chondrocyte implantation in the repair of chondral lesions of the knee: economics and quality of life.

Autologous chondrocyte implantation (ACI) has proven clinically effective in restoring hyaline-like cartilage to isolated chondral defects of the knee. This study prospectively examined the efficacy of treatment and quality of life in 44 patients undergoing ACI for full-thickness cartilage lesions and calculated the average cost per additional quality-adjusted life year. The 12-month results of ACI treatment showed improvement in patient function as measured by both the Knee Society score (114.02 to 140.67, or a 23% mean improvement, P < .001) and the Western Ontario and McMaster Universities Osteoarthritis Index (35.30 to 23.82, or a 33% mean improvement, P < .05). Quality of life, as measured by the Short Form-36 Physical Component Summary, was dramatically enhanced from 33.32 prior to biopsy to 41.48 (P < .05) 12 months after implantation. Improvement on all three scales was maintained during the period from 12 to 24 months after surgery. The estimated cost per additional quality-adjusted life year was $6791. This cost-effectiveness ratio was minimally sensitive to reasonable changes in effectiveness, patient age, or procedure cost. The procedure remained cost effective even when assumptions were less favorable than those in the base case. ACI improves patient quality of life, and it is an appropriate, cost-effective treatment for cartilage lesions of the knee.