Cost-Effectiveness of Bariatric Surgery Prior to Total Knee Arthroplasty in the Morbidly Obese: A Computer Model-Based Evaluation

The Journal of Bone and Joint Surgery. American Volume
Alexander S McLawhornEmily R Dodwell

Abstract

Obesity is associated with adverse outcomes and increased costs after total knee arthroplasty. Bariatric surgery is an effective treatment for morbid obesity, but its cost-effectiveness for weight loss prior to total knee arthroplasty is unknown. The purpose of this study was to evaluate the cost-effectiveness of bariatric surgery prior to total knee arthroplasty for patients in whom medical treatment of obesity and knee osteoarthritis had failed. A state-transition Markov model was constructed to compare the cost-utility of two treatment protocols for patients with morbid obesity and end-stage knee osteoarthritis: (1) immediate total knee arthroplasty and (2) bariatric surgery two years prior to the total knee arthroplasty. The probability of transition for each health state and its utility were derived from the literature. Costs, expressed in 2012 United States dollars, were estimated with use of administrative and claims data. Costs and utilities were discounted at 3% annually, and effectiveness was expressed in quality-adjusted life-years (QALYs). The principal outcome measure was the incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were performed, using $100,000 per QALY...Continue Reading

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Citations

Sep 23, 2016·The Journal of Bone and Joint Surgery. American Volume·James T NinomiyaStephen J Incavo
Nov 7, 2018·The Journal of Bone and Joint Surgery. American Volume·Michael J ChenDerek F Amanatullah
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Sep 1, 2021·Regional Anesthesia and Pain Medicine·Jiabin LiuStavros G Memtsoudis
Jun 10, 2019·Osteoarthritis and Cartilage·A HungD L Riddle

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