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
© 2024. The Author(s)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
PharmacoEconomics - open - 8(2024), 2 vom: 06. Feb., Seite 235-249 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Goldberg, Andrew J [VerfasserIn] |
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| Anmerkungen: |
Date Revised 25.02.2024 published: Print-Electronic ClinicalTrials.gov: NCT02128555 Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1007/s41669-023-00449-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366804960 |
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| 100 | 1 | |a Goldberg, Andrew J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cost-Utility Analysis of Total Ankle Replacement Compared with Ankle Arthrodesis for Patients Aged 50-85 Years with End-Stage Ankle Osteoarthritis |b The TARVA Study |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 25.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT02128555 | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Bordea, Ekaterina |e verfasserin |4 aut | |
| 700 | 1 | |a Chowdhury, Kashfia |e verfasserin |4 aut | |
| 700 | 1 | |a Hauptmannova, Iva |e verfasserin |4 aut | |
| 700 | 1 | |a Blackstone, James |e verfasserin |4 aut | |
| 700 | 1 | |a Brooking, Deirdre |e verfasserin |4 aut | |
| 700 | 1 | |a Deane, Elizabeth L |e verfasserin |4 aut | |
| 700 | 1 | |a Bendall, Stephen |e verfasserin |4 aut | |
| 700 | 1 | |a Bing, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Blundell, Chris |e verfasserin |4 aut | |
| 700 | 1 | |a Dhar, Sunil |e verfasserin |4 aut | |
| 700 | 1 | |a Molloy, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Milner, Steve |e verfasserin |4 aut | |
| 700 | 1 | |a Karski, Mike |e verfasserin |4 aut | |
| 700 | 1 | |a Hepple, Steve |e verfasserin |4 aut | |
| 700 | 1 | |a Siddique, Malik |e verfasserin |4 aut | |
| 700 | 1 | |a Loveday, David T |e verfasserin |4 aut | |
| 700 | 1 | |a Mishra, Viren |e verfasserin |4 aut | |
| 700 | 1 | |a Cooke, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Halliwell, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Townshend, David |e verfasserin |4 aut | |
| 700 | 1 | |a Skene, Simon S |e verfasserin |4 aut | |
| 700 | 1 | |a Doré, Caroline J |e verfasserin |4 aut | |
| 700 | 0 | |a TARVA Study Group |e verfasserin |4 aut | |
| 700 | 1 | |a Brown, Rick |e investigator |4 oth | |
| 700 | 1 | |a Butler, Michael |e investigator |4 oth | |
| 700 | 1 | |a Chadwick, Carolyn |e investigator |4 oth | |
| 700 | 1 | |a Clough, Tim |e investigator |4 oth | |
| 700 | 1 | |a Cullen, Nick |e investigator |4 oth | |
| 700 | 1 | |a Davies, Mark |e investigator |4 oth | |
| 700 | 1 | |a Davies, Howard |e investigator |4 oth | |
| 700 | 1 | |a Doré, Caroline |e investigator |4 oth | |
| 700 | 1 | |a Goldberg, Andrew |e investigator |4 oth | |
| 700 | 1 | |a Harries, Bill |e investigator |4 oth | |
| 700 | 1 | |a Hill, Simon |e investigator |4 oth | |
| 700 | 1 | |a Khoo, Michael |e investigator |4 oth | |
| 700 | 1 | |a Loveday, David T |e investigator |4 oth | |
| 700 | 1 | |a Makwana, Nilesh |e investigator |4 oth | |
| 700 | 1 | |a Marquis, Chris |e investigator |4 oth | |
| 700 | 1 | |a Murty, An |e investigator |4 oth | |
| 700 | 1 | |a Najefi, Ali |e investigator |4 oth | |
| 700 | 1 | |a O'Donnell, Paul |e investigator |4 oth | |
| 700 | 1 | |a Raglan, Martin |e investigator |4 oth | |
| 700 | 1 | |a Ramaskandhan, Jayasree |e investigator |4 oth | |
| 700 | 1 | |a Rogers, Mark |e investigator |4 oth | |
| 700 | 1 | |a Sakellariou, Anthony |e investigator |4 oth | |
| 700 | 1 | |a Skene, Simon |e investigator |4 oth | |
| 700 | 1 | |a Smith, George |e investigator |4 oth | |
| 700 | 1 | |a Smith, Robert |e investigator |4 oth | |
| 700 | 1 | |a Solan, Matt |e investigator |4 oth | |
| 700 | 1 | |a Thomas, Rhys |e investigator |4 oth | |
| 700 | 1 | |a Torres, Paulo |e investigator |4 oth | |
| 700 | 1 | |a Welck, Matthew |e investigator |4 oth | |
| 700 | 1 | |a Winson, Ian |e investigator |4 oth | |
| 700 | 1 | |a Zaidi, Razi |e investigator |4 oth | |
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