Faucett SC, Liu S, Krych AJ, Kurzweil PR, LaPrade RF, Pietzsch JB. Exploratory cost-effectiveness evaluation of different treatment strategies for meniscus root tears [abstract PMS34]. Poster presentation to the 2017 annual meeting of the International Society for Pharmacoeconomics and Outcomes Research, Boston, 20–24 May 2017. Value Health. 2017;20(5):A146.

Objectives. Medial meniscus root tears are common among patients over 50 years of age, and are the biomechanical equivalent of a total meniscectomy, which typically leads to the rapid advancement of knee osteoarthritis. Studies have documented the clinical consequences of conservative therapy, meniscectomy and meniscus root repair, but limited information is available related to their long-term costs. Our objective was to explore the cost-effectiveness of these differing treatment strategies in the United States.

Methods. A Markov model was constructed to project strategy-specific progression to symptomatic osteoarthritis (OA), total knee arthroplasty (TKA), and revision TKA in a cohort of 50-year old patients presenting with no significant OA at time of treatment. Failure rates of repair and meniscectomy procedures were accounted for. Utilities, costs, and event rates were based on literature and public databases. Analyses considered a 10-year timeframe, and explored the effects of parameter uncertainty and of different analysis horizons.

Results. Over 10 years, 45.8% of the meniscectomy and non-treated patients were projected to have undergone TKA, compared to 29.3% of repair patients. Discounted 10-year costs were $15,864 for repair, compared to $17,943 and $20,972 for no treatment and meniscectomy. Projected quality-adjusted life years (QALYs) were 7.03, 6.75, and 6.72, respectively, yielding repair to be associated with most favorable outcomes at concurrent cost savings of $2,079 compared to next best strategy. Repair was either cost-effective or dominant across a broad range of OA progression and repair failure rates. Analysis horizons of 2 years or longer found repair to be cost-effective, and dominant for horizons of 6 years or more.

Conclusions. Our model-based projections suggest that repair of meniscal root tears is associated with improved mid- and long-term outcomes and cost savings relative to both meniscectomy and conservative therapy, making repair the most cost-effective strategy for meniscal root tears.