Evaluating meniscus allograft transplant using a cost-effectiveness threshold analysis

Background: It is unknown if meniscal allograft transplant (MAT) delays progression of osteoarthritis (OA). Cost-effectiveness threshold analysis can demonstrate the necessary delay in OA progression required by MAT to be considered cost-effective compared to non-operative management. The purpose of this study is to identify the efficacy MAT requires in delaying progression to OA in previously meniscectomized knees in order to be considered cost-effective compared to non-operative treatment. A secondary goal is to demonstrate the influence of age and BMI on the required efficacy of MAT for cost-effectiveness. Methods: A Markov model was developed to evaluate the cost-effectiveness of MAT compared to non-operative management for patients with prior meniscectomy. Input parameters were identified in existing literature. Cost was derived from literature and The PearlDiver Patient Records Database. The required rate of OA progression was compared across treatment modalities to determine how effective MAT is required to be cost-effective. Results: MAT needs to be 31% more effective in delaying OA compared to non-operative interventions in order to be cost-effective. MAT is most cost-effective in 20-29 year-old patients, requiring a 25% greater efficacy in delaying OA. Obesity (BMI 30-35) makes MAT less cost-effective when compared to non-obese patients; however, the difference in required efficacy in delaying OA among obese patient when compared to non-operative management is approximately 10%. Conclusions: MAT needs to be approximately one-third more effective in delaying OA in previously meniscectomized knees to be considered cost-effective. Younger, non-obese patients have the lowest required efficacy of MAT to be cost-effective. (C) 2018 Elsevier B.V. All rights reserved.