Knee Replacement in Obese OA is Cost Effective Save
Debates over ideal candidates for total knee replacement (TKR) in osteoarthritis patients often excludes those who are obese, but a recent article in the Annals of Internal Medicine suggests that TKR is both effective and cost-effective in obese patients (BMI >40 kg/m2) with end-stage knee osteoarthritis.
TKR candidates with OA knee and a BMI of 40 kg/m2 or greater were assessed by cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually.
Total knee replacement increased QALYs by 0.71 year and lifetime medical costs by $25 200 among patients aged 50 to 65 years with a BMI of 40 kg/m2 or greater, resulting in an ICER of $35,200.
Total knee replacement in patients older than 65 years with a BMI of 40 kg/m2 or greater increased QALYs by 0.39 year and costs by $21,100, resulting in an ICER of $54 100.
Even patients with comorbidities (diabetes or cardiovascular disease), the ICERs were below $75,000 per QALY.
Overall, if judging a $55,000-per-QALY willingness-to-pay threshold, TKR was 100% cost-effective for patients aged 50 to 65 years; 90% for those over 65 years.