Cost-Utility Analysis of Total Ankle Replacement Compared with Ankle Arthrodesis for Patients Aged 50–85 Years with End-Stage Ankle Osteoarthritis: The TARVA Study

期刊论文
出版模式：

开放获取
发表日期：

2024年1月8日

查看全文

Andrew J. Goldberg,
Ekaterina Bordea,
Kashfia Chowdhury,
Iva Hauptmannova,
James Blackstone,
Deirdre Brooking,
Elizabeth L. Deane,
Stephen Bendall,
Andrew Bing,
Chris Blundell,
Sunil Dhar,
Andrew Molloy,
Steve Milner,
Mike Karski,
Steve Hepple,
Malik Siddique,
David T. Loveday,
Viren Mishra,
Paul Cooke,
Paul Halliwell,
David Townshend,
Simon S. Skene,
Caroline J. Doré,
Rick Brown,
Michael Butler,
Carolyn Chadwick,
Tim Clough,
Nick Cullen,
Mark Davies,
Howard Davies,
Caroline Doré,
Andrew Goldberg,
Bill Harries,
Simon Hill,
Michael Khoo,
David T. Loveday,
Nilesh Makwana,
Chris Marquis,
An Murty,
Ali Najefi,
Paul O’Donnell,
Martin Raglan,
Jayasree Ramaskandhan,
Mark Rogers,
Anthony Sakellariou,
Simon Skene,
George Smith,
Robert Smith,
Matt Solan,
Rhys Thomas,
Paulo Torres,
Matthew Welck,
Ian Winson,
Razi Zaidi

摘要

Background

Patients with end-stage ankle osteoarthritis suffer from reduced mobility and quality of life and the main surgical treatments are total ankle replacement (TAR) and ankle fusion (AF).

Objectives

Our aim was to calculate the mean incremental cost per quality-adjusted life-year (QALY) of TAR compared with AF in patients with end-stage ankle osteoarthritis, over 52 weeks and over the patients’ lifetime.

Method

We conducted a cost-utility analysis of 282 participants from 17 UK centres recruited to a randomised controlled trial (TARVA). QALYs were calculated using index values from EQ-5D-5L. Resource use information was collected from case report forms and self-completed questionnaires. Primary analysis was within-trial analysis from the National Health Service (NHS) and Personal Social Services (PSS) perspective, while secondary analyses were within-trial analysis from wider perspective and long-term economic modelling. Adjustments were made for baseline resource use and index values.

Results

Total cost at 52 weeks was higher in the TAR group compared with the AF group, from the NHS and PSS perspective (mean adjusted difference £2539, 95% confidence interval [CI] £1142, £3897). The difference became very small from the wider perspective (£155, 95% CI − £1947, £2331). There was no significant difference between TAR and AF in terms of QALYs (mean adjusted difference 0.02, 95% CI − 0.015, 0.05) at 52 weeks post-operation. The incremental cost-effectiveness ratio (ICER) was £131,999 per QALY gained 52 weeks post-operation. Long-term economic modelling resulted in an ICER of £4200 per QALY gained, and there is a 69% probability of TAR being cost effective at a cost-effectiveness threshold of £20,000 per QALY gained.

Conclusion

TAR does not appear to be cost effective over AF 52 weeks post-operation. A decision model suggests that TAR can be cost effective over the patients’ lifetime but there is a need for longer-term prospectively collected data.

Clinical trial registration

ISRCTN60672307 and ClinicalTrials.gov NCT02128555.