Markov Models for Cost-Effectiveness Analysis of Knee Arthroscopy: A Systematic Review

Abstract

OBJECTIVES: The purpose of this study is to review the existing literature on the cost-effectiveness of knee arthroscopy procedures with the objective of assessing the variability in assumptions, methodologies and results across different Markov analyses. DESIGN: Systematic review of study designs involving a Markov model or probabilistic cost-effectiveness analysis specific to knee arthroscopy. MAIN OUTCOME MEASURES: Main outcome measures comprised estimates of cost-effectiveness, including incremental cost-effectiveness ratio (ICER) comparisons and cost per quality-adjusted life year (QALY) ratios. RESULTS: The initial search identified 474 studies, with 7 articles meeting the inclusion criteria after screening and review. The included studies exhibited heterogeneity in participant demographic, design, interventions, and outcomes. The majority of studies reported superior cost-effectiveness in favor of meniscus repair and against meniscectomy. Additional analyses included evidence favoring diagnostic needle arthroscopy to MRI; early drilling of osteochondral defects to nonoperative management; and early intervention to delayed treatment. CONCLUSION: This review demonstrated substantial variability in estimates of cost-effectiveness, methodologies, and outcomes within the literature on knee arthroscopy procedures. Despite the heterogeneity, several trends emerged indicating favorable cost-effectiveness for several arthroscopic procedures for knee pathology. However, disparities in methodology and the lack of standardized reporting guidelines pose limitations to generalization of these interpretations. Future research should focus on standardized methodologies and reporting, as well as long-term clinical and economical studies. This review underscores the need for larger data sets for assumptions made in Markov models used in assessing the cost-effectiveness of knee arthroscopy procedures. LEVEL OF EVIDENCE: IV; systematic review of level IV or higher evidence