MENISCAL ALLOGRAFT TRANSPLANTATION IS A COST-EFFECTIVE ALTERNATIVE TO PARTIAL MENISCECTOMY FOR TORN LATERAL DISCOID MENISCUS

Purpose:

   Patients with lateral discoid knee meniscus injury are at increased risk for early onset osteoarthritis requiring total knee arthroplasty (TKA).  Optimal management for this condition is controversial given the up-front cost difference between the two treatment options: the more expensive meniscal allograft transplantation compared with standard partial meniscectomy.  We hypothesize that meniscal allografts for lateral discoid meniscus tears are more cost-effective compared with partial meniscectomy because allografts will extend time to TKA.

Methods:  

   A decision analytic Markov model was developed with TreeAge Pro 15 to compare the cost-effectiveness of two treatments for torn lateral discoid meniscus: meniscal allograft and partial meniscectomy.  Our patient population was athletic young women ages 25-30 years old without preexisting injury.  Our primary outcomes were years to TKA, total costs, and the incremental cost-per-year-to-TKA gained. We ran 1000 hypothetical subjects through the model for 25 years with a one-year cycle length.  Subjects were treated by meniscal allograft or partial meniscectomy and could enter subsequent health states of no clinical issues, reoperation, reinjury, or TKA (absorbing state) (Figure 1). Probability estimates were derived from the scientific literature or expert estimates when unavailable.  Cost estimates were obtained from 2014 Medicare reimbursement rates. Benefits and costs were discounted at 3%. One-way sensitivity analyses were conducted on key variables to test the robustness of our model.

Results:

   Over 25 years, partial meniscectomy cost $16,530, whereas meniscal allograft cost on average $320 more at $16,850. Partial meniscectomy postponed TKA an average of 12.5 years, compared to 17.30 years for meniscal allograft, a difference of 4.8 years. Allograft costs $68 per-year-gained in time to TKA. Sensitivity analysis found that as long as the allograft lasts at least 9 years (vs. 20 years in base case), it will be the more effective option with nearly equivalent costs to partial meniscectomy. The meniscal allograft must cost less than $1575 to be both less expensive and more effective than partial meniscectomy.

  

Conclusions:

   Meniscal allografts have been shown to reduce pain and improve function in patients with lateral discoid meniscus tears.  Our study supports the use of meniscal allografts in delaying TKA for these patients; meniscal allografts were more effective than partial meniscectomy with a nearly equivalent cost for the 25-year follow-up period.