Purpose
To evaluate the cost-effectiveness of treating isolated red-red zone, vertical meniscal
tears with either isolated meniscal repair (IMR) or partial meniscectomy (PM) in the
young adult using conservative modeling.
Methods
A decision-analytic Markov disease progression model with a 40-year horizon was created
simulating outcomes after IMR or PM for an isolated meniscal tear. Event probabilities,
costs, and utilities were used for the index procedures, and the development of osteoarthritis
(OA) and subsequent need for knee arthroplasty were calculated or selected from the
published literature. Differences in cost, difference in quality-adjusted life years
(QALYs), and the incremental cost effect ratio were calculated to determine which
index procedure is most cost effective.
Results
Total direct costs from PM were modeled at $38,648, and the total direct costs of
IMR were $23,948, resulting in a projected cost savings of $14,700 with IMR. There
was a modeled gain in QALYs of 17 for PM and 21 for IMR, resulting in an increase
in 4 QALYs for the IMR treatment group. This results in an incremental cost effect
ratio of $3,935 per QALY, favoring IMR as the dominant procedure.
Conclusions
Meniscal repair for isolated red-red zone, vertical meniscal tears was predicted to
have lower direct costs and improve QALYs compared with partial meniscectomy over
40-year modeling, indicating isolated meniscal repair to be the cost-effective procedure
in the treatment of an isolated meniscal tear in the young adult population.
Level of Evidence
Level 3: economic and decision analysis.
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Article info
Publication history
Accepted:
June 13,
2019
Received:
November 14,
2018
Footnotes
See commentary on page 3287
The authors report the following potential conflicts of interest or sources of funding: J.F. reports other from Arthrex and Smith and Nephew. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Save the Meniscus? Show Me the Money!ArthroscopyVol. 35Issue 12
- PreviewThe meniscus is known to play a vital role in the knee joint from, shock absorption to increased contact area to joint lubrication. Repairing a torn meniscus costs money, but it can be even more expensive to perform a partial meniscectomy over the long term. Moreover, meniscal repair may result in an improved quality of life for the patient. One must consider both quality of life and costs when addressing repairable meniscal tears in patients. Repairing a vertical meniscus tear in the red-red zone in a young adult is a cost-effective strategy.
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