Meniscal tears are the most common knee condition requiring surgery, and represent a substantial disease burden with clinical and cost implications. The success rates partial meniscectomy and meniscal repair have been studied, but limited information is available investigating their long-term costs and effects. Our objective was to assess the long-term cost-effectiveness of meniscal repair compared to meniscectomy.
We constructed a decision-analytic Markov disease progression model, using strategy-specific failure rates and treatment-specific probabilities for the development of osteoarthritis (OA) and subsequent knee replacement (TKR). Failure rates and OA incidence were derived from controlled and uncontrolled studies as well as meta-analyses. Costs were derived from 2014U.S. reimbursement amounts and published literature.
Meniscal repair was associated with an increased failure rate (RR of 4.37), but meaningful reductions in OA and TKR incidence (29.7% vs. 39.4% and 19.6% vs. 27.9%, respectively) in our model-based analysis. Over the 30-year horizon, meniscal repair was associated with an increase in discounted QALYs to 16.52 (compared to 16.37 QALYs for meniscectomy), at overall discounted savings of $2384, making it the dominant index procedure strategy. Using age-specific per-patient cost and QALYs projected for the 30-year horizon, our computations suggest that payers could save approximately $43 million annually if 10% of current meniscectomies could be performed as meniscal repairs.
Our projection suggests that meniscal repair, despite substantially higher failure rates, is associated with improved long-term outcomes and cost savings relative to meniscectomy in the majority of patients, making it the dominant treatment strategy.