Economic Evaluation of Total Knee Replacement Compared with Non-Surgical Management for Knee Osteoarthritis in India

Amatullah Sana Qadeer, Ananda Meher, Jennifer Rachel, Winnie Paulson, Abhilash Patra, Naline Gandhi, Nirupama Ay, Lipika Nanda, Sarit Kumar Rout and Ambarish Dutta ()
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Amatullah Sana Qadeer: Indian Institute of Public Health-Hyderabad, Institute of Public Health Sciences
Ananda Meher: Kalinga Institute of Industrial Technology University
Jennifer Rachel: Indian Institute of Public Health-Hyderabad, Institute of Public Health Sciences
Winnie Paulson: Indian Institute of Public Health-Hyderabad, Institute of Public Health Sciences
Abhilash Patra: Indian Institute of Public Health-Hyderabad, Institute of Public Health Sciences
Naline Gandhi: Duke-NUS Medical School
Nirupama Ay: Indian Institute of Public Health-Hyderabad, Institute of Public Health Sciences
Lipika Nanda: Indian Institute of Public Health-Hyderabad, Institute of Public Health Sciences
Sarit Kumar Rout: Indian Institute of Public Health-Bhubaneswar, Public Health Foundation of India
Ambarish Dutta: Indian Institute of Public Health-Bhubaneswar, Public Health Foundation of India

PharmacoEconomics - Open, 2025, vol. 9, issue 2, No 4, 217-229

Abstract: Abstract Objective This study is an economic evaluation of total knee replacement (TKR) in comparison with non-surgical management in India. Methods Cost-utility analysis and budget impact analysis (BIA) were conducted on individuals aged ≥ 50 years with osteoarthritis of the knee (OA knee) Kellgren-Lawrence grades 2 and 3 using a provider’s perspective. Three scenarios were considered, varying the age at which TKR is administered while assuming a 20-year lifespan for the implant. A Markov model was used to determine incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was conducted incorporating implant costs and other input parameters. Results Net quality-adjusted life-years (QALYs) gained per OA knee treated with TKR were superior when performed at the age of 50, regardless of OA severity and across all scenarios. The lowest ICER was 36,107 Indian National Rupees (INR) (USD 482.9)/QALY gained, observed at 50 years, while the highest was INR 61,363 (USD 820.72)/QALY gained at 70 years for grade-2 severity. Sensitivity analysis revealed that the ICER was most sensitive to the cost of non-surgical management, health utility values gained in an improved state, and the cost of TKR across scenarios. For the BIA in Scenario 1, with 40% coverage for TKR, costs reach INR 5013 crores (cr) (USD 670,477,060) in 2023 and INR 8444 cr (USD 1,024,628,736) in 2028 (1% of government budgets). In Scenario 2 (full coverage), costs are INR 12,532 cr (USD 1,520,683,008) (2.7%) in 2023, declining to 2.4% in 2028. In Scenario 3, covering 40% under the National Health Mission (NHM), costs vary from 17% in 2023 to 25% in 2028. Conclusion This study concludes that TKR is a cost-effective treatment option compared with non-surgical management for OA knee in India, irrespective of age, implant types, and severity.

Date: 2025
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DOI: 10.1007/s41669-024-00541-3

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