Purpose: Horizontal Cleavage meniscus Tears (HCTs) are a common knee injury that can lead to accelerated osteoarthritis and Total Knee Replacements (TKRs). Research suggests that Meniscus Repair (MR) lowers the risk of patients developing osteoarthritis when compared to Partial Meniscectomy (PM). MR also has a higher risk of procedure failure that results in additional procedures. This cost-utility analysis compares the costs and outcomes associated with these two treatments for HCTs to determine their cost-effectiveness.

Methods: We developed a Markov model from a US payer perspective to project treatment costs and Quality-Adjusted Life Years (QALYs) in a cohort of 35-year-old patients presenting with a HCT without osteoarthritis at baseline. The model consisted of 7 health states including osteoarthritis (OA), procedure failure states (with and without OA), post-TKR, and post-revision-TKR. Transition probabilities, costs, and utilities were obtained from the literature. Model results are presented as Incremental Cost-Effectiveness Ratios (ICERs) and interpreted using a Willingness to Pay (WTP) threshold of $100,000/QALY. We conducted both One-Way Sensitivity Analysis (OWSA), varying the time horizon and average age of the cohort, and Probabilistic Sensitivity Analysis (PSA) to assess the effects of parameter uncertainty on model results.

Results: MR was found to dominate PM over a lifetime horizon since it increased QALYs by 0.33 per patient and a decreased cost by $9,642 per patient. Sensitivity analysis showed that MR was not cost-effective in Year 1, cost-effective from Year 2, and cost-saving from Year 5 onwards. The PSA found MR to be cost-effective in approximately 91% of 10,000 iterations. These findings were largely driven by the impact of MR in reducing the progression of OA, offsetting the higher failure rate.

Conclusions: This analysis suggests that, where appropriate, MR should be considered a cost-effective alternative to PM and may provide an opportunity for cost-savings in the short-term.