Genicular artery embolization for knee osteoarthritis: a systematic review with meta-analysis and cost-analysis

IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Aránzazu Hernández-Yumar , Yadira González-Hernández , Tasmania del Pino-Sedeño , Cristina Valcárcel-Nazco , Aythami de Armas-Castellano , Estefanía Herrera-Ramos , Julián Portero Navarro , Montserrat Carmona-Rodríguez , María Ximena Rojas-Reyes , María M. Trujillo-Martín
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Abstract

Objective

To assess the effectiveness, safety, and cost-effectiveness of genicular artery embolization (GAE) for the treatment of mild or moderate knee osteoarthritis (KO) refractory to standard treatment, and/or severe KO in individuals not eligible for surgery.

Method

We conducted a systematic review with meta-analysis, supplemented by a cost-analysis, comparing GAE and standard treatment, from the perspective of the Spanish National Health System (NHS) over a one-year time horizon. The health improvement required for GAE to be deemed cost-effective was quantified, considering a willingness-to-pay threshold of 25 000 €/quality-adjusted life year (QALY).

Results

We included two randomized controlled trials in our analysis. Pain estimates showed inconsistent results, and no significant effects were observed for overall function, health-related quality of life, or changes in the need for pain management medication. No serious complications or major adverse events were observed. GRADE quality of evidence ranged from moderate to low. No economic evaluations were identified. Our cost-analysis revealed that GAE would result in an incremental cost of € 3432.37 per patient, requiring a health improvement of 0.137 QALY per patient to be deemed a cost-effective technology.

Conclusions

In summary, based on moderate to low-certainty evidence, it remains inconclusive whether there is any difference between GAE and standard treatment for KO. However, the use of GAE would increase the costs. Larger randomized controlled trials are needed to determine the effects of using GAE for chronic pain secondary to KO and, consequently, to ascertain whether this technology could potentially become cost-effective from the NHS perspective.
膝动脉栓塞治疗膝骨关节炎:荟萃分析和成本分析的系统回顾
目的评估膝动脉栓塞(GAE)治疗标准治疗难治性轻度或中度膝骨性关节炎(KO)和/或不适合手术治疗的重度KO的有效性、安全性和成本效益。方法我们从西班牙国家卫生系统(NHS)的角度,对GAE和标准治疗进行了为期一年的系统评价和荟萃分析,并辅以成本分析。考虑到愿意支付25 000欧元/质量调整生命年(QALY)的门槛,对认为GAE具有成本效益所需的健康改善进行了量化。结果我们纳入了两项随机对照试验。疼痛评估结果不一致,没有观察到对整体功能、健康相关生活质量或疼痛治疗药物需求的显著影响。未见严重并发症和重大不良事件。GRADE证据质量从中等到低。没有确定经济评价。我们的成本分析显示,GAE将导致每位患者3432.37欧元的增量成本,要求每位患者健康改善0.137 QALY才能被视为具有成本效益的技术。综上所述,基于中等到低确定性的证据,GAE与标准治疗对于KO是否存在差异尚不确定。然而,使用GAE会增加成本。需要更大规模的随机对照试验来确定使用GAE治疗KO继发慢性疼痛的效果,从而确定从NHS的角度来看,这项技术是否可能具有成本效益。
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来源期刊
Gaceta Sanitaria
Gaceta Sanitaria 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.10
自引率
5.30%
发文量
80
审稿时长
29 days
期刊介绍: Gaceta Sanitaria (Health Gazette) is an international journal that accepts articles in Spanish and in English. It is the official scientific journal of the Sociedad Española de Salud Publica y Administración Sanitaria (Spanish Society of Public Health and Health Administration) (SESPAS). The Journal publishes 6 issues per year on different areas of Public Health and Health Administration, including: -Applied epidemiology- Health prevention and promotion- Environmental health- International health- Management and assessment of policies and services- Health technology assessments- Health economics. The editorial process is regulated by a peer review system. It publishes original works, reviews, opinion articles, field and methodology notes, protocols, letters to the editor, editorials, and debates.
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