How are We Measuring Cost-Effectiveness in Total Joint Arthroplasty Studies? Systematic Review of the Literature

Abstract Introduction As volumes of total hip arthroplasty (THA) and total knee arthroplasty (TKA) continue to rise, it is important to understand their economic impact. No systematic review on cost-effectiveness of THA/TKA has been performed since 2016 despite recent changes in the healthcare environment. The purpose of the study was to provide a contemporary analysis of the cost-effectiveness of total joint arthroplasty and the use of quality-adjusted life years (QALYs). Methods A systematic review was performed from 2005-2020. Online databases (OVID Medline, PubMed, Cost-Effectiveness Analysis Registry, Google Scholar, EBSCO) were queried to identify economic analyses that evaluated the cost-effectiveness of THA/TKA. Results In total, 38 studies met the screening criteria. Study designs were primarily Markov models (68%), cohort studies (16%), and randomized trials (8%). Most studies adopted either a societal perspective (45%) or a health-system perspective (39%). Analysis revealed that THA/TKA were strongly cost-effective compared to non-surgical treatment. THA/TKA procedures that were not delayed were more cost-effective than delayed intervention. The majority of studies used quality-adjusted life years (QALYs) as the primary quality metric (82%); in all these studies there was a significant improvement in QALYs gained. Conclusions Given the high economic impact of arthroplasty, ongoing assessment of cost-effectiveness is needed. 24% of studies included in this systematic review were published in the last four years of this 15-year study period, highlighting the need for continuous assessment of aggregate data. Future studies should incorporate the cost-effectiveness of THA and TKA with respect to the work-value provided by surgeon providers to support health policy and reimbursement.