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Treating Hepatitis C Before Total Knee Arthroplasty is Cost-Effective: A Markov Analysis.

Authors
  • Kalyanasundaram, Gokul1
  • Feng, James E2
  • Congiusta, Frank3
  • Iorio, Richard4
  • DiCaprio, Matthew1
  • Anoushiravani, Afshin A1
  • 1 Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
  • 2 Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan.
  • 3 OrthoNY, Albany, New York.
  • 4 Department of Surgery, Brigham Women's Health, Boston, Massachusetts.
Type
Published Article
Journal
The Journal of arthroplasty
Publication Date
Feb 01, 2024
Volume
39
Issue
2
Pages
307–312
Identifiers
DOI: 10.1016/j.arth.2023.08.053
PMID: 37604270
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Patients who have the hepatitis C virus (HCV) have increased mortality and complication rates following total knee arthroplasty (TKA). Recent advances in HCV therapy have enabled clinicians to eradicate the disease using direct-acting antivirals (DAAs); however, its cost-effectiveness before TKA remains to be demonstrated. The aim of this study was to perform a cost-effectiveness analysis comparing no therapy to DAAs before TKA. A Markov model using input values from the published literature was performed to evaluate the cost-effectiveness of DAA treatment before TKA. Input values included event probabilities, mortality, cost, and health state quality-adjusted life-year (QALY) values for patients who have and do not have HCV. Patients who have HCV were modeled to have an increased rate of periprosthetic joint infection (PJI) infection (9.9 to 0.7%). The incremental cost-effectiveness ratio (ICER) of no therapy versus DAA was compared to a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to investigate the effects of uncertainty associated with input variables. Total knee arthroplasty in the setting of no therapy and DAA added 8.1 and 13.5 QALYs at a cost of $25,000 and $114,900. The ICER associated with DAA in comparison to no therapy was $16,800/QALY, below the willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses demonstrated that the ICER was affected by patient age, inflation rate, DAA cost and effectiveness, HCV-associated mortality, and DAA-induced reduction in PJI rate. Direct-acting antiviral treatment before TKA reduces risk of PJI and is cost-effective. Strong consideration should be given to treating patients who have HCV before elective TKA. Cost-effectiveness Analysis; Level III. Copyright © 2023 Elsevier Inc. All rights reserved.

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