The influence of implant survival on cost-effectiveness in total knee arthroplasty: a patient-level discrete-event simulation study
9 affiliations
- 1MBA Institute Chair for Medical and Biomechanical Research, University of Oviedo, Gijón, Spain
- 2University of Zaragoza, Zaragoza, Spain
- 3Associate Professor of Marketing and Market Research, University of Oviedo, Oviedo, Spain
- 4Full Professor of Business Organization, University of Oviedo, Oviedo, Spain
- 5University of Oviedo, Oviedo, Spain
- 6Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
- 7Hospital San Juan Grande, Cádiz, Spain
- 8Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- 9Hospital Universitario Miguel Servet - IIS Aragón, Zaragoza, Spain
Abstract
Background: Although several studies have evaluated the cost-effectiveness of total knee arthroplasty (TKA) compared with conservative treatment, few have explored how implant revision rates may influence its long-term cost-effectiveness. The objective of this study was to evaluate the impact of implant revision rates on quality of life and cost-effectiveness in patients undergoing TKA.
Methods: A cost-utility analysis from a healthcare system perspective was conducted using an individualized discrete-event simulation model parameterized with data from a Spanish cohort of patients undergoing TKA. Quality-adjusted life years were calculated with the SF-6D index, and implant alternatives were compared by assigning age- and sex-specific revision rates to each simulated patient while projecting long-term quality of life and life expectancy according to general population standards. The prosthetic models compared were those associated with the highest (WorstKnee) and lowest (BestKnee) revision rates in the UK National Joint Registry. The primary outcome was the incremental cost-effectiveness ratio. Secondary analyses included budget impact and deterministic sensitivity analyses.
Results: The projected quality-adjusted life expectancy over 15 years was 9.767 QALYs for WorstKnee, compared with 10.004 QALYs for BestKnee. The incremental cost-effectiveness ratio was €6,219/QALY, which remained below the cost-effectiveness thresholds commonly used in Spain. Use of BestKnee was associated with an additional cost of €332.3 M over 15 years; however, it also led to a substantial reduction in revision surgeries, with 27,878 fewer procedures performed, resulting in gradual cost savings over time.
Conclusion: Within the price ranges currently observed in the Spanish National Health System, total knee prostheses associated with lower revision rates provide a favorable long-term cost-effectiveness profile and may reduce future revision burden despite their higher acquisition cost.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13561-026-00822-z.
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BibTeX
@article{miguel2026influence,
title = {{The influence of implant survival on cost-effectiveness in total knee arthroplasty: a patient-level discrete-event simulation study}},
author = {Pablo Oscar Roza Miguel and Jorge Albareda Albareda and Nuria García-Rodríguez and Eduardo González Fidalgo and Daniel Hernández Vaquero and José Antonio Queiruga Dios and María Rabanal Rubio and Carlos Revenga Giertych and Fernando J Tavares Sánchez-Monge and Carlos Martín Hernández},
journal = {Health Economics Review},
year = {2026},
month = jul,
doi = {10.1186/s13561-026-00822-z},
url = {https://doi.org/10.1186/s13561-026-00822-z},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The influence of implant survival on cost-effectiveness in total knee arthroplasty: a patient-level discrete-event simulation study
AU - Pablo Oscar Roza Miguel
AU - Jorge Albareda Albareda
AU - Nuria García-Rodríguez
AU - Eduardo González Fidalgo
AU - Daniel Hernández Vaquero
AU - José Antonio Queiruga Dios
AU - María Rabanal Rubio
AU - Carlos Revenga Giertych
AU - Fernando J Tavares Sánchez-Monge
AU - Carlos Martín Hernández
PY - 2026
DA - 2026/07/17
JO - Health Economics Review
DO - 10.1186/s13561-026-00822-z
UR - https://doi.org/10.1186/s13561-026-00822-z
AB - Background: Although several studies have evaluated the cost-effectiveness of total knee arthroplasty (TKA) compared with conservative treatment, few have explored how implant revision rates may influence its long-term cost-effectiveness. The objective of this study was to evaluate the impact of implant revision rates on quality of life and cost-effectiveness in patients undergoing TKA. Methods: A cost-utility analysis from a healthcare system perspective was conducted using an individualized discrete-event simulation model parameterized with data from a Spanish cohort of patients undergoing TKA. Quality-adjusted life years were calculated with the SF-6D index, and implant alternatives were compared by assigning age- and sex-specific revision rates to each simulated patient while projecting long-term quality of life and life expectancy according to general population standards. The prosthetic models compared were those associated with the highest (WorstKnee) and lowest (BestKnee) revision rates in the UK National Joint Registry. The primary outcome was the incremental cost-effectiveness ratio. Secondary analyses included budget impact and deterministic sensitivity analyses. Results: The projected quality-adjusted life expectancy over 15 years was 9.767 QALYs for WorstKnee, compared with 10.004 QALYs for BestKnee. The incremental cost-effectiveness ratio was €6,219/QALY, which remained below the cost-effectiveness thresholds commonly used in Spain. Use of BestKnee was associated with an additional cost of €332.3 M over 15 years; however, it also led to a substantial reduction in revision surgeries, with 27,878 fewer procedures performed, resulting in gradual cost savings over time. Conclusion: Within the price ranges currently observed in the Spanish National Health System, total knee prostheses associated with lower revision rates provide a favorable long-term cost-effectiveness profile and may reduce future revision burden despite their higher acquisition cost. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13561-026-00822-z.
SN - 2191-1991
ER -