Total knee arthroplasty (TKA) is more cost-effective than medical treatment and achieves greater cost-effectiveness when done at high-volume centers, according to an Archives of Internal Medicine study.

06 july 2009--Using data from Medicare patients with end-stage knee osteoarthritis, researchers created a model to examine four treatment strategies: no replacement, or replacement performed at low-, medium-, and high-volume hospitals.

The authors found that knee replacement had an overall incremental cost-effectiveness ratio of $18,300 per quality-adjusted life year, compared with medical treatment alone. (In high-risk patients — those living in poverty, at greater age, or with more comorbidities — the ratio was higher, at $28,100. Patients having replacements done in high-volume centers had lower cost ratios.)

The authors conclude that "on a societal level, it is more cost-effective for [patients with end-stage knee osteoarthritis] to undergo TKA than to not have TKA, regardless of hospital TKA volume."

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