HealthDay News — Total knee replacement (TKR) seems to be good value from a cost-effectiveness perspective for patients with a body mass index (BMI) of ≥40 kg/m2, according to a study published online March 23 in the Annals of Internal Medicine.

Angela T. Chen, from Brigham and Women’s Hospital in Boston, and colleagues used a cost-effectiveness analysis to examine the value of TKR in recipients with a BMI of 40 kg/m2 or greater in the United States. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were examined.

The researchers found that in the base-case analysis, among patients aged 50 to 65 years with a BMI ≥40 kg/m2, TKR increased QALYs by 0.71 year and lifetime medical costs by $25,200, resulting in an ICER of $35,200. For patients older than 65 years, TKR increased QALYs by 0.39 year and costs by $21,100, resulting in an ICER of $54,100. In the sensitivity analysis, for TKR recipients with a BMI ≥40 kg/m2 and diabetes and cardiovascular disease, ICERs were less than $75,000 per QALY. At a $55,000-per-QALY willingness-to-pay threshold, the likelihood of TKR being a cost-effective strategy for patients aged 50 to 65 years and those older than 65 years was 100 and 90 percent, respectively, in the probabilistic sensitivity analysis.


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“Our analysis suggests that withholding TKR from persons with a BMI of 40 kg/m2 or greater may not be justified from an effectiveness or a cost-effectiveness perspective,” the authors write.

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