Cost-Utility Analysis of Total Ankle Replacement Compared with Ankle Arthrodesis for Patients Aged 50–85 Years with End-Stage Ankle Osteoarthritis: The TARVA Study

Andrew J. Goldberg, Ekaterina Bordea (), Kashfia Chowdhury, Iva Hauptmannova, James Blackstone, Deirdre Brooking, Elizabeth L. Deane, Stephen Bendall, Andrew Bing, Chris Blundell, Sunil Dhar, Andrew Molloy, Steve Milner, Mike Karski, Steve Hepple, Malik Siddique, David T. Loveday, Viren Mishra, Paul Cooke, Paul Halliwell, David Townshend, Simon S. Skene and Caroline J. Doré
Additional contact information
Andrew J. Goldberg: Royal Free Hospital
Ekaterina Bordea: University College London
Kashfia Chowdhury: University College London
Iva Hauptmannova: Royal National Orthopaedic Hospital (RNOH)
James Blackstone: University College London
Deirdre Brooking: Royal National Orthopaedic Hospital (RNOH)
Elizabeth L. Deane: University College London
Stephen Bendall: University Hospitals Sussex NHS Foundation Trust
Andrew Bing: The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
Chris Blundell: Sheffield Teaching Hospitals NHS Trust, Northern General Hospital
Sunil Dhar: Nottingham University Hospitals NHS Trust
Andrew Molloy: Liverpool University Hospitals NHS Foundation Trust
Steve Milner: University Hospitals of Derby and Burton NHS Foundation Trust
Mike Karski: Wrightington, Wigan and Leigh NHS Foundation Trust
Steve Hepple: North Bristol NHS Trust
Malik Siddique: Freeman Hospital
David T. Loveday: Norfolk and Norwich University Hospital Colney Lane
Viren Mishra: Hull Royal Infirmary
Paul Cooke: Nuffield Orthopaedic Centre
Paul Halliwell: Royal Surrey NHS Foundation Trust
David Townshend: Northumbria Healthcare NHS Foundation Trust
Simon S. Skene: University of Surrey
Caroline J. Doré: University College London

PharmacoEconomics - Open, 2024, vol. 8, issue 2, No 6, 235-249

Abstract: Abstract Background Patients with end-stage ankle osteoarthritis suffer from reduced mobility and quality of life and the main surgical treatments are total ankle replacement (TAR) and ankle fusion (AF). Objectives Our aim was to calculate the mean incremental cost per quality-adjusted life-year (QALY) of TAR compared with AF in patients with end-stage ankle osteoarthritis, over 52 weeks and over the patients’ lifetime. Method We conducted a cost-utility analysis of 282 participants from 17 UK centres recruited to a randomised controlled trial (TARVA). QALYs were calculated using index values from EQ-5D-5L. Resource use information was collected from case report forms and self-completed questionnaires. Primary analysis was within-trial analysis from the National Health Service (NHS) and Personal Social Services (PSS) perspective, while secondary analyses were within-trial analysis from wider perspective and long-term economic modelling. Adjustments were made for baseline resource use and index values. Results Total cost at 52 weeks was higher in the TAR group compared with the AF group, from the NHS and PSS perspective (mean adjusted difference £2539, 95% confidence interval [CI] £1142, £3897). The difference became very small from the wider perspective (£155, 95% CI − £1947, £2331). There was no significant difference between TAR and AF in terms of QALYs (mean adjusted difference 0.02, 95% CI − 0.015, 0.05) at 52 weeks post-operation. The incremental cost-effectiveness ratio (ICER) was £131,999 per QALY gained 52 weeks post-operation. Long-term economic modelling resulted in an ICER of £4200 per QALY gained, and there is a 69% probability of TAR being cost effective at a cost-effectiveness threshold of £20,000 per QALY gained. Conclusion TAR does not appear to be cost effective over AF 52 weeks post-operation. A decision model suggests that TAR can be cost effective over the patients’ lifetime but there is a need for longer-term prospectively collected data. Clinical trial registration ISRCTN60672307 and ClinicalTrials.gov NCT02128555.

Date: 2024
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DOI: 10.1007/s41669-023-00449-4

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