Research Article|Articles in Press

Platelet-Rich-Plasma and Marrow Venting May Serve as Cost-Effective Augmentation Techniques for Isolated Meniscal Repair: A Decision-Analytic Markov Model-Based Analysis



      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.


      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).


      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.


      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.
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