{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T10:52:39Z","timestamp":1793875959505,"version":"4.7.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,10,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There has been increased utilization of surgical options for the treatment of end-stage unicompartmental arthritis in patients at both extremes of the age spectrum. The purpose of this study was to determine how these changing paradigms affected the lifetime cost-effectiveness of total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and nonsurgical treatment (NST).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Using a Markov decision analytic model, we assessed how lifetime costs and quality-adjusted life years (QALYs) vary as a function of age at the time of initial treatment (ATIT) of patients with end-stage unicompartmental knee osteoarthritis undergoing TKA, UKA, and NST. Separate models were estimated for ATITs at 5-year intervals from 40 through 90 years. Direct medical costs, QALYs, and transition probabilities were determined from the published literature. Indirect costs (lost wages, Social Security disability collections, and value of missed workdays) were calculated. Cost-effectiveness and incremental cost-effectiveness ratios (ICERs) were calculated for each treatment at each ATIT. The model assumed no crossover from NST to UKA or TKA. ICERs were compared with a willingness-to-pay threshold of 50,000 U.S. dollars, and a 1-way sensitivity analysis was used to assess the robustness of ICER-based treatment decisions. Societal savings were estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In the base-case model, surgical treatments were less expensive and provided a greater number of QALYs than NST from 40 to 69 years of age. From 70 years of age and onward, surgical treatments remained cost-effective compared with NST, with ICERs remaining below the societal willingness-to-pay threshold. When surgical treatments were compared, UKA dominated TKA for all ATITs. The preferential use of UKA in all U.S. patients with unicompartmental osteoarthritis would result in an estimated lifetime societal savings of 987 million to 1.5 billion U.S. dollars per annual wave of patients undergoing treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this preliminary assessment, recent expansion of surgical treatments into younger and older age demographics appears to be cost-effective in the setting of unicompartmental knee osteoarthritis. Our findings suggest that NST should be used sparingly in patients below the age of 70 years and UKA should be chosen over TKA in order to maximize cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Economic and decision analysis\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.17.00837","type":"journal-article","created":{"date-parts":[[2018,10,4]],"date-time":"2018-10-04T01:07:33Z","timestamp":1538615253000},"page":"1653-1660","source":"Crossref","is-referenced-by-count":38,"title":["Cost-Effectiveness of Surgical and Nonsurgical Treatments for Unicompartmental Knee Arthritis"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2726-2417","authenticated-orcid":false,"given":"Gregory S.","family":"Kazarian","sequence":"first","affiliation":[{"name":"Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1168-1513","authenticated-orcid":false,"given":"Jess H.","family":"Lonner","sequence":"additional","affiliation":[{"name":"Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9039-8256","authenticated-orcid":false,"given":"Mitchell G.","family":"Maltenfort","sequence":"additional","affiliation":[{"name":"Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1291-5278","authenticated-orcid":false,"given":"Hassan M.K.","family":"Ghomrawi","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Pediatrics, Center for Healthcare Studies, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2040-8188","authenticated-orcid":false,"given":"Antonia F.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,10,3]]},"reference":[{"issue":"2","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1136\/ard.59.2.81","article-title":"The bone and joint decade 2000-2010","volume":"59","author":"Woolf","year":"2000","journal-title":"Ann Rheum Dis."},{"issue":"2","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1002\/acr.22412","article-title":"Lifetime medical costs of knee osteoarthritis management in the United States: impact of extending indications for total knee arthroplasty","volume":"67","author":"Losina","year":"2015","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"12","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1001\/2012.jama.11153","article-title":"Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010","volume":"308","author":"Cram","year":"2012","journal-title":"JAMA."},{"issue":"8","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"624","DOI":"10.2106\/JBJS.M.00285","article-title":"Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021","volume":"96","author":"Kurtz","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.arth.2007.04.012","article-title":"Yearly incidence of unicompartmental knee arthroplasty in the United States","volume":"23","author":"Riddle","year":"2008","journal-title":"J Arthroplasty."},{"issue":"11","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1302\/0301-620X.87B11.16324","article-title":"Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age","volume":"87","author":"Price","year":"2005","journal-title":"J Bone Joint Surg Br."},{"issue":"10","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"2606","DOI":"10.1007\/s11999-009-0834-6","article-title":"Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030","volume":"467","author":"Kurtz","year":"2009","journal-title":"Clin Orthop Relat Res."},{"issue":"10","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.2106\/00004623-200310000-00016","article-title":"Unicompartmental knee arthroplasty in patients sixty years of age or younger","volume":"85-A","author":"Pennington","year":"2003","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"396","DOI":"10.2106\/JBJS.N.00169","article-title":"Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the U.S.","volume":"97","author":"Ghomrawi","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"38","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta7380","article-title":"Estimating implied rates of discount in healthcare decision-making","volume":"7","author":"West","year":"2003","journal-title":"Health Technol Assess."},{"issue":"14","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1001\/jama.1996.03540140060028","article-title":"Panel on Cost-Effectiveness in Health and Medicine. The role of cost-effectiveness analysis in health and medicine","volume":"276","author":"Russell","year":"1996","journal-title":"JAMA."},{"issue":"3","key":"bib12-20230810","first-page":"1","article-title":"United States life tables, 2008","volume":"61","author":"Arias","year":"2012","journal-title":"Natl Vital Stat Rep."},{"issue":"12","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1001\/archinternmed.2009.136","article-title":"Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume","volume":"169","author":"Losina","year":"2009","journal-title":"Arch Intern Med."},{"issue":"8","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.arth.2012.03.022","article-title":"Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis","volume":"27","author":"Brown","year":"2012","journal-title":"J Arthroplasty."},{"issue":"15","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1001\/jama.1996.03540150055031","article-title":"Recommendations of the Panel on Cost-effectiveness in Health and Medicine","volume":"276","author":"Weinstein","year":"1996","journal-title":"JAMA."},{"issue":"16","key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.2106\/JBJS.L.01488","article-title":"The direct and indirect costs to society of treatment for end-stage knee osteoarthritis","volume":"95","author":"Ruiz","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/1478-7547-11-5","article-title":"Modeling the indirect economic implications of musculoskeletal disorders and treatment","volume":"11","author":"Dall","year":"2013","journal-title":"Cost Eff Resour Alloc."},{"issue":"7","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1016\/j.arth.2015.02.017","article-title":"Updating cost effectiveness analyses in orthopedic surgery: resilience of the $50,000 per QALY threshold","volume":"30","author":"Nwachukwu","year":"2015","journal-title":"J Arthroplasty."},{"issue":"8","key":"bib21-20230810","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.arth.2010.12.023","article-title":"Retrospective analysis of total knee arthroplasty cases for visual, histological, and clinical eligibility of unicompartmental knee arthroplasties","volume":"26","author":"Arno","year":"2011","journal-title":"J Arthroplasty."},{"issue":"4","key":"bib22-20230810","doi-asserted-by":"crossref","first-page":"342","DOI":"10.3109\/17453674.2014.920990","article-title":"Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals","volume":"85","author":"Badawy","year":"2014","journal-title":"Acta Orthop."},{"issue":"9","key":"bib23-20230810","first-page":"1975","article-title":"Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis","volume":"88","author":"Soohoo","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"9","key":"bib24-20230810","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.2106\/00004623-200409000-00008","article-title":"Association between hospital and surgeon procedure volume and the outcomes of total knee replacement","volume":"86-A","author":"Katz","year":"2004","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib25-20230810","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.knee.2012.10.019","article-title":"Mortality and perioperative complications after unicompartmental knee arthroplasty","volume":"20","author":"Morris","year":"2013","journal-title":"Knee."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201810030-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:45Z","timestamp":1787751885000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201810030-00004"}},"subtitle":["A Markov Model"],"short-title":[],"issued":{"date-parts":[[2018,10,3]]},"references-count":23,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.17.00837","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,3]]}}}