No Significant Difference in Cost or Outcomes at 1‐Year Minimum Follow‐Up After Arthroscopic Partial Meniscectomy Comparing 1.9 mm Distal Chip‐on‐Tip Needlescope Versus 4 mm Glass Rod Lens Arthroscope: Both Treatments Are Highly Cost‐Effective
James H. Lubowitz, Chad LavenderPurpose
To evaluate cost, outcomes, and incremental cost‐effectiveness of arthroscopic partial meniscectomy comparing visualization using a 1.9 mm distal chip‐on‐tip needlescope versus a standard 4 mm glass rod lens arthroscope.
Methods
We retrospectively reviewed prospectively collected data (from a larger randomized controlled trial) on patients having partial meniscectomy performed by 1 surgeon at 1 facility between February 2023 and February 2025. International Knee Documentation Committee and visual analog scale pain scores at 1‐year minimum follow‐up, costs, cost‐effectiveness (cost/quality‐adjusted life years [QALYs]), and incremental cost‐effectiveness ratio (cost of 1 additional year of life in perfect health) were collected. Sensitivity analyses were assessed for potential variations in cost or effectiveness.
Results
Twenty‐four patients are included in each group; mean follow‐up is 26 months (range 12‐36). Comparing needle versus standard, mean age (years) is 50 versus 46.5 ( P = .19); percent male sex is 71 versus 46 ( P = .14); improvement in International Knee Documentation Committee is 58.7 versus 48.7 ( P = .24); improvement in visual analog scale is 5.4 versus 4.5 ( P = .55). Mean cost per case is $17,236.69 versus $16,994.00 ( P = .26). Cost‐effectiveness is $1177.32/QALY versus $1215.59/QALY. The incremental cost‐effectiveness ratio is $367.71. Sensitivity analysis shows that if the costs of needle decreased to equal the costs of standard, needle becomes cost‐neutral while providing superior outcomes (dominant), and if the effectiveness of standard arthroscopy increased to equal needle, needle becomes dominated (more expensive, effectiveness neutral).
Conclusions
Arthroscopic partial meniscectomy comparing 1.9 mm distal chip‐on‐tip needlescope versus 4 mm glass rod lens arthroscope results in no significant differences in cost or outcomes at 1‐year minimum follow‐up. Both treatments are highly cost‐effective. Incremental cost‐effectiveness ratio for needlescope compared with arthroscope, $367.71, is more than 2 orders of magnitude lower than the willingness‐to‐pay threshold of $50,000/QALY.
Level of Evidence
Level IV, economic: input data from Level III study and uncertainty as examined by univariate sensitivity analysis.