Feeley B, Liu S, Garner A, Zhang A, Pietzsch JB. The cost-effectiveness of meniscal repair versus partial meniscectomy: a model-based projection of clinical outcomes and costs in the United States healthcare system [Presentation to the annual meeting of the International Society for Pharmacoeconomics and Outcomes Research, abstract PMS32].Value Health. 2015;18(3):A158; doi: 10.1016/j.jval.2015.03.917.

Objectives.Meniscal tears are the most common knee condition requiring surgery, and represent a substantial disease burden with long-term clinical and cost implications. Research performed over the past two decades has shed light on the success rates of the two primary treatment strategies—partial meniscectomy and meniscus repair. However, only limited information is available about the long-term costs and effects of these strategies. Our objective was to assess the long-term cost-effectiveness of meniscus repair compared to meniscectomy.

Methods.We constructed a decision-analytic Markov disease progression model, taking into account index strategy-specific failure rates as well as treatment-specific probabilities for the development of osteoarthritis (OA) and subsequent total knee replacement (TKR). Failure rates and OA incidence were derived from a review of controlled and uncontrolled studies as well as recent meta-analyses. Costs were derived from current (2014) U.S. national average reimbursement amounts and the published literature. We computed the 20-year incremental cost-effectiveness ratio (ICER) and relative event risks in a cohort of 38-year-old patients, 21% of whom were female.

Results.Over the 20-year horizon, meniscus repair was associated with a gradual increase in discounted quality-adjusted life years (QALYs) from 12.84 to 12.99. At overall discounted savings of $2,598 when compared to meniscectomy, meniscus repair was found to be the dominant index procedure strategy.

While the meniscus repair strategy was associated with an increased failure rate (RR of 6.12), it led to substantial reductions in OA and TKR incidence (16.0% vs. 29.4%, and 8.5% vs. 16.1%, respectively). Clinical benefit and cost-effectiveness further improved with longer follow-up.

Conclusions.Our model-based projection suggests that meniscus repair, despite substantially higher initial failure rates, is associated with improved long-term outcomes and overall cost savings relative to meniscectomy, making it the dominant treatment strategy from a health-economic perspective.