hta_ knee intro.qxp - Ministero della Salute

Executive summary
One-liner
Decision makers should privilege, in their activities, the use of the more cost-effective prosthesis
models, linking purchase price with effectiveness estimates.
Background
Total knee replacement (TKR) is known as an effective procedure for patients with osteoarthritis
(OA). The wide array of prosthesis models on the market makes the issuing of evidencebased
guidance on choice, a priority for the equitable and transparent use of resources in any
health system.
The assessment of the clinical value of each model, from the viewpoint of a national health
system, requires data on:
i) which models are used in practice;
ii) acceptable estimates of performance for those models;
iii) their price.
Aim
We aimed to identify the TKR prostheses currently used in Italy, to retrieve evidence of performance
for all the models identified from clinical studies and arthroplasty registers, and to construct
a cost-effectiveness model to support the choice for healthcare payers.
Methods
We first performed a context-specific analysis to identify which prosthesis models are currently
in use and their purchase prices. We involved 172 public hospitals and private accredited providers
of the Italian national health service.
Then we carried out a systematic review of evidence from clinical studies and an analysis of
implant performance from arthroplasty registers. We were interested in recipients aged 50 and
above that had received primary TKR and had been followed for at least 5 years.
Finally, with the purchase prices and the effectiveness estimates identified, we carried out an
economic evaluation to compare the different models.
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