Cost-utility of osteoarticular allograft versus endoprosthetic reconstruction for primary bone sarcoma of the knee: A markov analysis
Corresponding Author
Robert J. Wilson
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Correspondence
Robert J. Wilson, MD, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774.
Email: [email protected]
Search for more papers by this authorLina M. Sulieman
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorJacob P. VanHouten
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorJennifer L. Halpern
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorHerbert S. Schwartz
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorClinton J. Devin
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorGinger E. Holt
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorCorresponding Author
Robert J. Wilson
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Correspondence
Robert J. Wilson, MD, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774.
Email: [email protected]
Search for more papers by this authorLina M. Sulieman
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorJacob P. VanHouten
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorJennifer L. Halpern
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorHerbert S. Schwartz
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorClinton J. Devin
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorGinger E. Holt
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
Search for more papers by this authorAbstract
BACKGROUND
The most cost-effective reconstruction after resection of bone sarcoma is unknown. The goal of this study was to compare the cost effectiveness of osteoarticular allograft to endoprosthetic reconstruction of the proximal tibia or distal femur.
METHODS
A Markov model was used. Revision and complication rates were taken from existing studies. Costs were based on Medicare reimbursement rates and implant prices. Health-state utilities were derived from the Health Utilities Index 3 survey with additional assumptions. Incremental cost-effectiveness ratios (ICER) were used with less than $100 000 per quality-adjusted life year (QALY) considered cost-effective. Sensitivity analyses were performed for comparison over a range of costs, utilities, complication rates, and revisions rates.
RESULTS
Osteoarticular allografts, and a 30% price-discounted endoprosthesis were cost-effective with ICERs of $92.59 and $6 114.77. One-way sensitivity analysis revealed discounted endoprostheses were favored if allografts cost over $21 900 or endoprostheses cost less than $51 900. Allograft reconstruction was favored over discounted endoprosthetic reconstruction if the allograft complication rate was less than 1.3%. Allografts were more cost-effective than full-price endoprostheses.
CONCLUSIONS
Osteoarticular allografts and price-discounted endoprosthetic reconstructions are cost-effective. Sensitivity analysis, using plausible complication and revision rates, favored the use of discounted endoprostheses over allografts. Allografts are more cost-effective than full-price endoprostheses.
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