Cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy for medial compartment knee osteoarthritis in young patients: a Canadian public payer perspective
Bibliographic record
Abstract
BACKGROUND: In medial compartment osteoarthritis (OA) of the knee in young patients who fail conservative treatment, clinical equipoise exists between three surgical strategies: (1) total knee arthroplasty (TKA), (2) unicompartmental knee arthroplasty (UKA), and (3) medial opening wedge high tibial osteotomy (HTO). This study evaluated the cost-effectiveness of three surgical strategies, using a probabilistic Markov model from the Ontario public payer perspective in Canada. METHODS: A probabilistic Markov model was developed to perform a cost-utility analysis comparing TKA, UKA, and HTO. The base case simulated a 45-year-old Canadian cohort with unilateral medial knee OA over a lifetime horizon. Outcomes included quality-adjusted life months (QALMs), discounted lifetime costs (1.5% annually), incremental cost-effectiveness ratios (ICERs), and net monetary benefit (NMB), reported in 2023 Canadian dollars (CAD, $). A willingness to pay (WTP) threshold of $4,166.67/QALM was applied. Model uncertainty was assessed via 3,000 iterations of probabilistic sensitivity analysis. Scenario analyses using sex-specific mortality rates were also conducted. RESULTS: Mean costs were $9,157 (TKA), $9,238 (HTO), and $9,419 (UKA). UKA produced the highest QALMs (290.53), followed by TKA (277.02) and HTO (270.88). HTO was absolutely dominated, as it was both more costly and less effective than TKA. Among undominated strategies, UKA yielded an ICER of $19.46/QALM compared to TKA. UKA also had the highest NMB ($1,201,112), outperforming TKA ($1,145,110) and HTO ($1,119,411). UKA was the most cost-effective option in 55.27% of probabilistic simulations, followed by TKA (23.83%) and HTO (20.90%). Scenario analyses with sex-specific mortality showed similar trends. CONCLUSIONS: UKA is the most cost-effective surgical strategy from a public payer perspective for young patients with medial knee OA. At a WTP of $4,166.67/QALM, UKA balances long-term durability and economic value better than TKA or HTO. LEVEL OF EVIDENCE: Level III, Model-based economic evaluation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".