The cost-effectiveness of meniscal repair versus partial meniscectomy: A model-based projection for the United States

• The cost effectiveness of meniscal debridement or repair is not known.
• A Markov model of to compare meniscal treatment strategies was developed.
• Repair was associated with increased failure rates but reductions in TKA rate.
• Meniscal repair was also associated with a discounted savings of $2384.
• Meniscal repair is the dominant cost strategy up to age 55.

BackgroundMeniscal 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.MethodsWe 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 2014 U.S. reimbursement amounts and published literature.ResultsMeniscal 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.ConclusionsOur 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.