Cost-Utility Analysis of Immediate Total Knee Arthroplasty Versus Preoperative Platelet-Rich Plasma Injections: A Markov Model from the French Payer Perspective
Moustafa Naja, Gabriel Fernandez de grado, Dominique Scipioni, Nadia Benkirane-Jessel, Anne-Marie Musset, Damien OffnerObjective:
To assess whether immediate total knee arthroplasty (TKA) is cost-effective compared with a strategy of 3 preoperative platelet-rich plasma (PRP) injections in patients with knee osteoarthritis, from the perspective of the French national health insurance.
Methods:
We developed a Markov model with a 30-y horizon. Transition probabilities, costs, and health-state utilities were used to estimate discounted costs, quality-adjusted life-years (QALYs), and cost-effectiveness outcomes. Deterministic and probabilistic sensitivity analyses were performed. Cost-effectiveness acceptability curves and the expected value of perfect information were estimated using the net monetary benefit framework.
Results:
In the base case, immediate TKA increased discounted costs but also increased discounted QALYs compared with PRP. Per patient, discounted costs were €23,111 for immediate TKA and €15,338 for PRP, and discounted QALYs were 15.29 and 14.77, respectively. The incremental cost-effectiveness ratio for immediate TKA versus PRP was €14,800 per QALY gained, below the illustrative €30,000/QALY threshold. Deterministic sensitivity analyses showed that results were mainly driven by assumptions regarding the duration of full benefit after PRP and TKA as well as by early treatment–response transitions. In probabilistic analysis, immediate TKA was cost-effective in approximately 55% of simulations at €30,000/QALY, indicating substantial decision uncertainty.
Conclusions:
Under the stated assumptions, immediate TKA appears cost-effective compared with preoperative PRP, although decision uncertainty remains substantial.