Sustained Acoustic Medicine Is a Cost-Effective, Noninvasive Treatment Option for Knee Osteoarthritis Compared With Intra-articular Hyaluronan Injections and Total Knee Arthroplasty: A Health Economic Evaluation
Jason Krystofiak, Stephanie Petterson, Kevin Plancher, Samuel Phillips, Jemy DelikatBackground:
Sustained acoustic medicine (SAM) is a wearable ultrasound device shown to have analgesic effects on knee osteoarthritis (OA). However, its cost-effectiveness relative to current treatment options, specifically intra-articular hyaluronan (IAHA) injections and total knee arthroplasty (TKA), has not been evaluated.
Purpose:
To compare SAM, IAHA injections, and TKA treatment options for knee OA sequentially on a cost-effectiveness basis in the United States.
Study Design:
Economic and decision analysis; Level of evidence, 2.
Methods:
A state-transition Markov model was developed to compare SAM, IAHA, and TKA with a 6-month cycle and a 60-year horizon. The model included 10,000 patients with mild/moderate knee OA per group aged 40 years with sensitivity analysis for 70 years. Patients would proceed through treatments sequentially, from SAM to IAHA to TKA, as treatments became ineffective. Probabilities, costs, and functional effectiveness were derived from published literature and government sources, including Social Security Administration and the Department of Veterans Affairs. Clinical outcome data used to determine parameters included 1315 patients (range, 40-72 years, SAM), 17,445 patients (50 to 70 years, IAHA), and 815,901 patients (40 to 88 years, TKA). The model was run 3 times, assuming the whole population started with SAM, IAHA, or TKA, respectively. Deterministic and probabilistic sensitivity analyses were conducted to test model robustness. Utilities were converted to quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated comparing the three starting treatment options with a willingness-to-pay threshold of $50,000.
Results:
Starting with TKA was less effective and more expensive than the other two strategies. SAM had higher QALYs per patient than IAHA treatment with a small increase in cost per patient, leading to an overall ICER of $11,394. Sensitivity analyses confirmed the results are unaffected by perturbations in model parameters.
Conclusion:
Our study demonstrated that at a conventional willingness-to-pay cutoff of $50,000, SAM is a cost-effective, noninvasive treatment option for knee OA that should be considered as an initial treatment option before IAHA or TKA by decision makers.