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Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation

INTRODUCTION: Cartilage defects in the knee can be caused by injury, various types of arthritis, or degeneration. As a long-term consequence of cartilage defects, osteoarthritis can develop over time, often leading to the need for a total knee replacement (TKR). The treatment alternatives of chondra...

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Autores principales: Vogelmann, Tobias, Roessler, Philip P., Buhs, Matthias, Ostermeier, Sven, Gille, Justus, Hoburg, Arnd, Zöllner, York, Schwarz, Sebastian, Schubert, Tino, Grebe, Marco, Zinser, Wolfgang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9957880/
https://www.ncbi.nlm.nih.gov/pubmed/35064292
http://dx.doi.org/10.1007/s00402-021-04318-9
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author Vogelmann, Tobias
Roessler, Philip P.
Buhs, Matthias
Ostermeier, Sven
Gille, Justus
Hoburg, Arnd
Zöllner, York
Schwarz, Sebastian
Schubert, Tino
Grebe, Marco
Zinser, Wolfgang
author_facet Vogelmann, Tobias
Roessler, Philip P.
Buhs, Matthias
Ostermeier, Sven
Gille, Justus
Hoburg, Arnd
Zöllner, York
Schwarz, Sebastian
Schubert, Tino
Grebe, Marco
Zinser, Wolfgang
author_sort Vogelmann, Tobias
collection PubMed
description INTRODUCTION: Cartilage defects in the knee can be caused by injury, various types of arthritis, or degeneration. As a long-term consequence of cartilage defects, osteoarthritis can develop over time, often leading to the need for a total knee replacement (TKR). The treatment alternatives of chondral defects include, among others, microfracture, and matrix-associated autologous chondrocyte implantation (M-ACI). The purpose of this study was to determine cost-effectiveness of M-ACI in Germany with available mid- and long-term outcome data, with special focus on the avoidance of TKR. MATERIALS AND METHODS: We developed a discrete-event simulation (DES) that follows up individuals with cartilage defects of the knee over their lifetimes. The DES was conducted with a status-quo scenario in which M-ACI is available and a comparison scenario with no M-ACI available. The model included 10,000 patients with articular cartilage defects. We assumed Weibull distributions for short- and long-term effects for implant failures. Model outcomes were costs, number of TKRs, and quality-adjusted life years (QALYs). All analyses were performed from the perspective of the German statutory health insurance. RESULTS: The majority of patients was under 45 years old, with defect sizes between 2 and 7 cm(2) (mean: 4.5 cm(2)); average modeled lifetime was 48 years. In the scenario without M-ACI, 26.4% of patients required a TKR over their lifetime. In the M-ACI scenario, this was the case in only 5.5% of cases. Thus, in the modeled cohort of 10,000 patients, 2700 TKRs, including revisions, could be avoided. Patients treated with M-ACI experienced improved quality of life (22.53 vs. 21.21 QALYs) at higher treatment-related costs (18,589 vs. 14,134 € /patient) compared to those treated without M-ACI, yielding an incremental cost‐effectiveness ratio (ICER) of 3376 € /QALY. CONCLUSION: M-ACI is projected to be a highly cost‐effective treatment for chondral defects of the knee in the German healthcare setting. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00402-021-04318-9.
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spelling pubmed-99578802023-02-26 Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation Vogelmann, Tobias Roessler, Philip P. Buhs, Matthias Ostermeier, Sven Gille, Justus Hoburg, Arnd Zöllner, York Schwarz, Sebastian Schubert, Tino Grebe, Marco Zinser, Wolfgang Arch Orthop Trauma Surg Orthopaedic Surgery INTRODUCTION: Cartilage defects in the knee can be caused by injury, various types of arthritis, or degeneration. As a long-term consequence of cartilage defects, osteoarthritis can develop over time, often leading to the need for a total knee replacement (TKR). The treatment alternatives of chondral defects include, among others, microfracture, and matrix-associated autologous chondrocyte implantation (M-ACI). The purpose of this study was to determine cost-effectiveness of M-ACI in Germany with available mid- and long-term outcome data, with special focus on the avoidance of TKR. MATERIALS AND METHODS: We developed a discrete-event simulation (DES) that follows up individuals with cartilage defects of the knee over their lifetimes. The DES was conducted with a status-quo scenario in which M-ACI is available and a comparison scenario with no M-ACI available. The model included 10,000 patients with articular cartilage defects. We assumed Weibull distributions for short- and long-term effects for implant failures. Model outcomes were costs, number of TKRs, and quality-adjusted life years (QALYs). All analyses were performed from the perspective of the German statutory health insurance. RESULTS: The majority of patients was under 45 years old, with defect sizes between 2 and 7 cm(2) (mean: 4.5 cm(2)); average modeled lifetime was 48 years. In the scenario without M-ACI, 26.4% of patients required a TKR over their lifetime. In the M-ACI scenario, this was the case in only 5.5% of cases. Thus, in the modeled cohort of 10,000 patients, 2700 TKRs, including revisions, could be avoided. Patients treated with M-ACI experienced improved quality of life (22.53 vs. 21.21 QALYs) at higher treatment-related costs (18,589 vs. 14,134 € /patient) compared to those treated without M-ACI, yielding an incremental cost‐effectiveness ratio (ICER) of 3376 € /QALY. CONCLUSION: M-ACI is projected to be a highly cost‐effective treatment for chondral defects of the knee in the German healthcare setting. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00402-021-04318-9. Springer Berlin Heidelberg 2022-01-22 2023 /pmc/articles/PMC9957880/ /pubmed/35064292 http://dx.doi.org/10.1007/s00402-021-04318-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Orthopaedic Surgery
Vogelmann, Tobias
Roessler, Philip P.
Buhs, Matthias
Ostermeier, Sven
Gille, Justus
Hoburg, Arnd
Zöllner, York
Schwarz, Sebastian
Schubert, Tino
Grebe, Marco
Zinser, Wolfgang
Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation
title Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation
title_full Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation
title_fullStr Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation
title_full_unstemmed Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation
title_short Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation
title_sort long-term cost-effectiveness of matrix-associated chondrocyte implantation in the german health care system: a discrete event simulation
topic Orthopaedic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9957880/
https://www.ncbi.nlm.nih.gov/pubmed/35064292
http://dx.doi.org/10.1007/s00402-021-04318-9
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