Monday, July 15, 2024

Effectiveness and Cost Analysis of Arthroscopic Partial Meniscectomy in Degenerative Meniscus Tears

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A recent study evaluates the cost-effectiveness and clinical outcomes of Arthroscopic Partial Meniscectomy (APM) compared to placebo surgery for patients with degenerative medial meniscus tears. Despite previous evidence indicating no significant clinical benefits of APM over conservative treatments, proponents argue for its cost-effectiveness. This research aims to clarify this aspect by examining postoperative costs and quality of life improvements.

Study Design and Methodology

The study involved 146 adults, aged 35 to 65 years, diagnosed with degenerative medial meniscus tears but without knee osteoarthritis. Participants were randomly assigned to either APM or placebo surgery groups. Both groups underwent standard diagnostic arthroscopy, but only the APM group received actual meniscal trimming. Follow-up care included a home-based exercise program. At the 2-year mark, researchers evaluated cost-effectiveness using incremental net monetary benefit (INMB) for quality-adjusted life years (QALY) from both societal and healthcare perspectives.

Findings and Cost Analysis

The analysis revealed that APM did not result in lower postoperative costs or significant improvements in quality of life compared to placebo surgery. From a societal viewpoint, APM incurred €971 more in costs and provided a minimal QALY improvement of 0.015, both statistically inconclusive. Using a willingness to pay (WTP) threshold of €35,000 per QALY, APM showed a negative INMB of €-460. This value only turned positive at a WTP threshold of approximately €65,000 per QALY, indicating uncertain cost-effectiveness.

Key Inferences

The study presents actionable insights:

  • APM does not reduce postoperative costs when compared to placebo surgery.
  • The quality of life improvements from APM are statistically negligible.
  • Cost-effectiveness of APM remains uncertain and highly dependent on WTP thresholds.
  • Clinical guidelines should continue recommending against APM for degenerative meniscus tears.

The study supports existing clinical guidelines advising against APM for degenerative meniscus tears, reinforcing previous findings that highlight no significant benefit or cost-effectiveness over nonsurgical treatments or placebo surgery. Given the consistency of these results, further research is unlikely to change current clinical recommendations.

Original Article: Clin Orthop Relat Res. 2024 May 7. doi: 10.1097/CORR.0000000000003094. Online ahead of print.

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