Objectives: To conduct a cost-effectiveness analysis between Coblation technology and mechanical debridement with a shaver (MD) in a patient population presenting with chronic pain due to a medial meniscus tear and an International Cartilage Research Society (ICRS) grade III focal chondral lesion. Methods: A decisionanalytic model was developed comparing costs and clinical outcomes between Coblation and MD following a knee chondroplasty procedure in a patient population with medial meniscus tear and an International Cartilage Research Society (ICRS) grade III focal chondral lesion. Costs were obtained from the 2016 Spanish Health Costs database, an annual 3% discount rate was applied to future costs. Clinical outcomes data were extracted from published results of a randomized clinical trial (RCT). The time horizon for the analysis was 4 years for both costs and outcomes. Model robustness was tested using threshold analysis and multiple one-way sensitivity analyses. Results: The RCT reported a lower revision rate with Coblation, 14% compared to 48% with MD (p= 0.006). Furthermore, patients treated with Coblation reported a significantly higher Knee Injury and Osteoarthritis Outcome Score (KOOS) at the end of the study (p= 0.001). Over a 4-year post-operative period, the estimated total cost per patient was 2,858 and 4,931 for Coblation and MD respectively resulting in cost-savings of 2,073 in favor of Coblation, making Coblation a dominant strategy as a result of lower costs and better improved clinical outcomes. The cost-saving realized with Coblation was robust to sensitivity analyses and threshold analysis determined that Coblation remained the dominant alternative when it was assumed that Coblation revision rate increased from the initially reported rate of 14% up to 69%. Conclusions: The use of Coblation technology vs. MD is a cost-effective option in the treatment of patients with a medial meniscus tear and idiopathic ICRS grade III defect.
Adeyemi, A., Nherera, L., Trueman, P., & Cano, J. (2017). Cost-Effectiveness Analysis Of Coblation Technology VS. Mechanical Debridement With A Shaver In The Treatment Of Knee Cartilage Lesions- A Spanish Payer Perspective. Value in Health, 20(9), A584. https://doi.org/10.1016/j.jval.2017.08.1050