Abstract
Purpose
To evaluate the cost-effectiveness of three isolated meniscal repair (IMR) treatment
strategies: platelet-rich plasma (PRP)-augmented IMR, IMR with a marrow venting procedure
(MVP), and IMR without biologic augmentation.
Methods
A Markov model was developed to evaluate the baseline case: a young adult patient
meeting the indications for IMR. Health utility values, failure rates, and transition
probabilities were derived from the published literature. Costs were determined based
on the typical patient undergoing IMR at an outpatient surgery center. Outcome measures
included costs, quality-adjusted life years (QALYs), and the incremental cost effect
ratio (ICER).
Results
Total costs from IMR with MVP were $8,250, total costs from PRP-augmented IMR were
$12,031, and total costs from IMR without PRP or MVP were $13,326. PRP-augmented IMR
resulted in an additional 2.16 QALYs, while IMR with MVP produced slightly less QALYs
at 2.13. Non-augmented repair produced a modeled gain of 2.02 QALYs. The ICER comparing
PRP-augmented IMR to MVP-augmented IMR was $161,742/QALY, which is well above the
$50,000 willingness-to-pay threshold.
Conclusions
IMR with biologic augmentation (MVP or PRP) resulted in a higher number of QALYs and
lower costs than non-augmented IMR, suggesting that biologic augmentation is cost-effective.
Total costs from IMR with MVP were significantly lower than those from PRP-augmented
IMR, while the additional QALYs produced from PRP-augmented IMR were only slightly
higher than those produced from IMR with MVP. As a result, neither treatment dominated
over the other. However, because the ICER for PRP-augmented IMR fell well above the
$50,000 willingness-to-pay threshold, IMR with MVP was determined the overall cost-effective
treatment strategy in the setting of young adult patients with isolated meniscal tears.
Level of Evidence
Level 3: economic and decision analysis.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006.J Bone Joint Surg Am. 2011; 93: 994-1000
- The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration.Biomaterials. 2011; 32: 7411-7431
- Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls.Arthritis Rheum. 2003; 48: 2178-2187
- Biomechanical analysis of the effect of medial meniscus degenerative and traumatic lesions on the knee joint.Am J Transl Res. 2019; 11: 542-556
- Second-Look Arthroscopic Evaluation of Healing Rates After Arthroscopic Repair of Meniscal Tears: A Systematic Review and Meta-analysis.Orthop J Sports Med. 2021; 923259671211038289
- Higher healing rate after meniscal repair with concomitant ACL reconstruction for tears located in vascular zone 1 compared to zone 2: a systematic review and meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2022; 30: 1976-1989
- Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus.Orthop Traumatol Surg Res. 2017; 103: S237-s244
- Meniscal Salvage: Where We Are Today.J Am Acad Orthop Surg. 2021; 29: 596-603
- Indications for meniscus repair.Clin Sports Med. 2012; 31: 1-14
- Current concepts in the techniques, indications and outcomes of meniscal repairs.Eur J Orthop Surg Traumatol. 2019; 29: 509-520
- High short-term return to sports rate despite an ongoing healing process after acute meniscus repair in young athletes.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 215-222
- Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes.Arthroscopy. 2011; 27: 1275-1288
Bansal S, Floyd ER, M AK, et al. Meniscal repair: The current state and recent advances in augmentation. J Orthop Res. 2021;39:1368-1382.
Rodriguez IA, Growney Kalaf EA, Bowlin GL, Sell SA. Platelet-rich plasma in bone regeneration: engineering the delivery for improved clinical efficacy. Biomed Res Int. 2014;2014:392398-392398.
- Effect of Human Serum and 2 Different Types of Platelet Concentrates on Human Meniscus Cell Migration, Proliferation, and Matrix Formation.Arthroscopy. 2016; 32: 1106-1116
- Meniscus Repair and Regeneration: A Systematic Review from a Basic and Translational Science Perspective.Clin Sports Med. 2020; 39: 125-163
- The Current Role of Biologics for Meniscus Injury and Treatment.Curr Rev Musculoskelet Med. 2022;
- Biological augmentation to promote meniscus repair: from basic science to clinic application—state of the art.Journal of ISAKOS. 2020; 5: 150-157
- Platelet-Rich Plasma Increases the Levels of Catabolic Molecules and Cellular Dedifferentiation in the Meniscus of a Rabbit Model.Int J Mol Sci. 2016; 17: 120
- Platelet-Rich Plasma Augmentation for Isolated Arthroscopic Meniscal Repairs Leads to Significantly Lower Failure Rates: A Systematic Review of Comparative Studies.Orthop J Sports Med. 2020; 82325967120964534
- Repair Augmentation of Unstable, Complete Vertical Meniscal Tears With Bone Marrow Venting Procedure: A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study.Arthroscopy. 2019; 35: 1500-1508.e1501
- Platelet-rich plasma for open meniscal repair in young patients: any benefit?.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 51-58
- The Cost Variability of Orthobiologics.Sports Health. 2020; 12: 94-98
- The Markov process in medical prognosis.Med Decis Making. 1983; 3: 419-458
- Incremental cost-effectiveness ratios (ICERs): the silence of the lambda.Soc Sci Med. 2006; 62: 2091-2100
- Updating cost-effectiveness--the curious resilience of the $50,000-per-QALY threshold.N Engl J Med. 2014; 371: 796-797
- Outcomes After Biologically Augmented Isolated Meniscal Repair With Marrow Venting Are Comparable With Those After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction.Am J Sports Med. 2017; 45: 1341-1348
- Arthroscopically Repaired Bucket-Handle Meniscus Tears: Patient Demographics, Postoperative Outcomes, and a Comparison of Success and Failure Cases.Cartilage. 2020; 11: 77-87
Platelet rich plasma (PRP) Therapy reimbursement overview. Available from: http://www.rsmedical.com/documents/331-0034-00-31reva.pdf . Accessed January 9, 2022.
- Cost-effectiveness analysis of the diagnosis of meniscus tears.Am J Sports Med. 2015; 43: 128-137
- A Cost-Effectiveness Analysis of Isolated Meniscal Repair Versus Partial Meniscectomy for Red-Red Zone, Vertical Meniscal Tears in the Young Adult.Arthroscopy. 2019; 35: 3280-3286
- Clinical efficacy of platelet-rich plasma as adjuvant therapy in patients undergoing arthroscopic repair of meniscal injury.J Int Med Res. 2020; 48300060520955059
- Augmentation of Meniscal Repair With Platelet-Rich Plasma: A Systematic Review of Comparative Studies.Orthop J Sports Med. 2020; 82325967120926145
- Use of Net Monetary Benefit Analysis to Comprehensively Understand the Value of Innovative Treatments.Value in Health. 2016; 19: A731
- Interpreting the results of cost-effectiveness studies.J Am Coll Cardiol. 2008; 52: 2119-2126
- The therapeutic value of arthroscopic microfracture technique in combination with platelet-rich plasma injection for knee cartilage injury.Am J Transl Res. 2021; 13: 2694-2701
- Arthroscopic repair of horizontal meniscal cleavage tears with marrow-stimulating technique.Arthroscopy. 2015; 31: 92-98
- Marrow stimulating technique to augment meniscus repair.Arthroscopy. 2003; 19: 794-798
- A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature.J Bone Joint Surg Am. 2017; 99: 1769-1779
- A matched-cohort population study of reoperation after meniscal repair with and without concomitant anterior cruciate ligament reconstruction.The American journal of sports medicine. 2013; 41: 349-355
- Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study.Knee Surgery, Sports Traumatology, Arthroscopy. 2011; 19: 1729-1734
- Why menisci show higher healing rate when repaired during ACL reconstruction? Growth factors release can be the explanation.Knee Surgery, Sports Traumatology, Arthroscopy. 2015; 23: 90-96
- A Modified Preparation Method of Ideal Platelet-Rich Fibrin Matrix From Whole Blood.Front Med (Lausanne). 2021; 8724488
- Interpenetrating Hydrogel Networks Enhance Mechanical Stability, Rheological Properties, Release Behavior and Adhesiveness of Platelet-Rich Plasma.Int J Mol Sci. 2020; 21: 1399
- Comparative Matched-Pair Analysis of the Injection Versus Implantation of Mesenchymal Stem Cells for Knee Osteoarthritis.Am J Sports Med. 2015; 43: 2738-2746
Article info
Publication history
Accepted:
February 15,
2023
Received in revised form:
February 6,
2023
Received:
September 1,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
All authors listed on the manuscript attest that they have provided:
1. Substantial contributions to the conception or design of the work; or the acquisition, analysis,
or interpretation of data for the work; AND
2. Drafting the work or revising it critically for important intellectual content; AND
3. Final approval of the version to be published; AND
4. Agreement to be accountable for all aspects of the work in ensuring that questions related to
the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Identification
Copyright
© 2023 Published by Elsevier on behalf of the Arthroscopy Association of North America
