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The cost-effectiveness of osteochondral allograft transplantation in the knee

PURPOSE: Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. They are used to repair combined defects of articular cartilage and bone. Such defects often occur in people far too young to have knee arthroplasty, for whom the main alternative to OCA i...

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Autores principales: Mistry, Hema, Metcalfe, Andrew, Smith, Nick, Loveman, Emma, Colquitt, Jill, Royle, Pamela, Waugh, Norman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541582/
https://www.ncbi.nlm.nih.gov/pubmed/30721344
http://dx.doi.org/10.1007/s00167-019-05392-8
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author Mistry, Hema
Metcalfe, Andrew
Smith, Nick
Loveman, Emma
Colquitt, Jill
Royle, Pamela
Waugh, Norman
author_facet Mistry, Hema
Metcalfe, Andrew
Smith, Nick
Loveman, Emma
Colquitt, Jill
Royle, Pamela
Waugh, Norman
author_sort Mistry, Hema
collection PubMed
description PURPOSE: Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. They are used to repair combined defects of articular cartilage and bone. Such defects often occur in people far too young to have knee arthroplasty, for whom the main alternative to OCA is conservative symptomatic care, which will not prevent development of osteoarthritis. The aim of this report was to assess the cost-effectiveness of osteochondral allograft transplantation in the knee. METHODS: Systematic review of evidence on clinical effectiveness and economic modelling. RESULTS: The evidence on osteochondral allograft transplantation comes from observational studies, but often based on good quality prospective registries of all patients having such surgery. Without controlled trials, it was necessary to use historical cohorts to assess the effect of osteochondral grafts. There is good evidence that OCA are clinically effective with a high graft survival rate over 20 years. If an OCA graft fails, there is some evidence that revision with a second OCA is also effective, though less so than primary OCA. Economic modelling showed that osteochondral allograft transplantation was highly cost-effective, with costs per quality adjusted life year much lower than many other treatments considered cost effective. CONCLUSIONS: Osteochondral allograft transplantation appears highly cost-effective though the cost per quality adjusted life year varies according to the widely varying costs of allografts. Based on one small study, revision OCA also appears very cost-effective, but more evidence is needed. LEVEL OF EVIDENCE: II. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00167-019-05392-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-65415822019-06-14 The cost-effectiveness of osteochondral allograft transplantation in the knee Mistry, Hema Metcalfe, Andrew Smith, Nick Loveman, Emma Colquitt, Jill Royle, Pamela Waugh, Norman Knee Surg Sports Traumatol Arthrosc Knee PURPOSE: Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. They are used to repair combined defects of articular cartilage and bone. Such defects often occur in people far too young to have knee arthroplasty, for whom the main alternative to OCA is conservative symptomatic care, which will not prevent development of osteoarthritis. The aim of this report was to assess the cost-effectiveness of osteochondral allograft transplantation in the knee. METHODS: Systematic review of evidence on clinical effectiveness and economic modelling. RESULTS: The evidence on osteochondral allograft transplantation comes from observational studies, but often based on good quality prospective registries of all patients having such surgery. Without controlled trials, it was necessary to use historical cohorts to assess the effect of osteochondral grafts. There is good evidence that OCA are clinically effective with a high graft survival rate over 20 years. If an OCA graft fails, there is some evidence that revision with a second OCA is also effective, though less so than primary OCA. Economic modelling showed that osteochondral allograft transplantation was highly cost-effective, with costs per quality adjusted life year much lower than many other treatments considered cost effective. CONCLUSIONS: Osteochondral allograft transplantation appears highly cost-effective though the cost per quality adjusted life year varies according to the widely varying costs of allografts. Based on one small study, revision OCA also appears very cost-effective, but more evidence is needed. LEVEL OF EVIDENCE: II. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00167-019-05392-8) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2019-02-05 2019 /pmc/articles/PMC6541582/ /pubmed/30721344 http://dx.doi.org/10.1007/s00167-019-05392-8 Text en © The Author(s) 2019 OpenAccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Knee
Mistry, Hema
Metcalfe, Andrew
Smith, Nick
Loveman, Emma
Colquitt, Jill
Royle, Pamela
Waugh, Norman
The cost-effectiveness of osteochondral allograft transplantation in the knee
title The cost-effectiveness of osteochondral allograft transplantation in the knee
title_full The cost-effectiveness of osteochondral allograft transplantation in the knee
title_fullStr The cost-effectiveness of osteochondral allograft transplantation in the knee
title_full_unstemmed The cost-effectiveness of osteochondral allograft transplantation in the knee
title_short The cost-effectiveness of osteochondral allograft transplantation in the knee
title_sort cost-effectiveness of osteochondral allograft transplantation in the knee
topic Knee
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541582/
https://www.ncbi.nlm.nih.gov/pubmed/30721344
http://dx.doi.org/10.1007/s00167-019-05392-8
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