Forecasting the value of innovation in total knee arthroplasty care: A headroom approach

Purpose: Total knee arthroplasty (TKA) is the standard treatment of end-stage osteoarthritis. TKA is often used and, therefore, poses a healthcare and societal burden, which is likely to increase further. Headroom analyses evaluate a technology under development by making assumptions about its effectiveness. This article applies a headroom approach to forecast the potential value of innovations that improve TKA-related care in the Netherlands in terms of cost-effectiveness and surgeries avoided.

Methods: A state-transition model estimating lifetime direct health effects, healthcare- and societal costs and percentage of avoide d surgeries was developed. The model compared care as usual to five hypothetical interventions to calculate the headroom associated with (1) preventing the need for TKAs, (2) preventing the need for all TKA revisions, (3) postponing TKAs without quality-of-life loss, (4) preventing periprosthetic joint infections (PJIs) and (5) improving patient satisfaction.

Results: Preventing the need for all TKAs amounted to €43,076 of headroom. Preventing the need for TKA revisions amounted to €2276 (5.8% of surgeries avoided), postponing TKAs by 5 years amounted to €7634 (32.4% of surgeries avoided), preventing PJIs amounted to €1187 (1.4% of surgeries avoided) and improving patient satisfaction amounted to €16,622 (0% of surgeries avoided). The headroom of each hypothetical intervention was highest in younger populations (<50 years of age).

Conclusion: There is a headroom for improving TKA-related care. Innovations to avoid or postpone TKA (i.e., joint-preserving treatments) as well as those that improve patient satisfaction can be effective in maximizing the value for money and avoiding surgeries. Due to the decreasing average patient age, innovations to reduce revision rates and PJIs will become more valuable as these are most effective in younger patients. It is currently unclear how cost-effectiveness considerations should be traded off against the prevention of surgery to reduce the increasing burden on the healthcare system.

Level of evidence: Level III economic evaluation/decision-analytic model.