Page 134 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F3.7 Clinical Safety and Quality Services I 14:30 Room 421

Cost Effectiveness Analysis of Cartilage Repair Surgery for Treatment of Cartilage Defects of the Knee in Hong
Kong
1
2
1
1
Yip WH , Chan KY , Qiu Y , Wong YB , Li W 1
2
1 Department of Orthopedic and Traumatology, Queen Elizabeth Hospital, Department of Engineering, The University of Hong
Kong, Hong Kong
Introduction
Damaged knee articular cartilage results in pain, functional impairment and mechanical symptoms; they also contribute
to early onset of osteoarthritis. Microfracture (MFX) procedure has been widely employed to treat this condition. In recent
years, regenerative techniques including matrix-induced autologous chondrocyte implantation (MACI) and autologous
matrix-induced chondrogenesis (AMIC) have been introduced. In Hong Kong, there is no previous analysis for the costs and
effectiveness of these treatments.
Objectives
To estimate the efficacy and cost effectiveness of such cartilage repair procedures in treating symptomatic articular cartilage
defects of the knee in the public health service of Hong Kong.
Monday, 7 May 2018 Patients receiving MFX, MACI or AMIC at the Queen Elizabeth Hospital between 2001 and 2015 were analysed in this cross-
Methodology

sectional study. Direct medical costs were calculated according to the Hospital Authority’s published rates and vendor price
lists corrected to 2015 Hong Kong Dollars. Clinical outcome was reported as knee-related functional outcome scores (KOOS
and WOMAC) and general health status (SF-12). Results were expressed in gain in functional scores (pre-op vs 24 months
post-op), and Quality-Adjusted Life-Years (QALYs), with utility scores derived from the SF-12 questionnaire responses.

Results
All three procedures showed clinical effectiveness in all 60 patients, relieving symptoms and restoring function. The functional
outcome scores (both the KOOS and WOMAC) were improved at 24th month. Subgroup analysis revealed that improvement
>30% was achieved in both the AMIC and MACI groups, but not the MFX group. QALYs also showed enhancement at
24th month after surgery in all three groups. The estimated cost per additional QALYs was also calculated, and the three
procedures seemed cost effective using both the UK and US thresholds.

Our study found that minimal clinically important difference (MCID) was achieved in both AMIC and MACI but not MFX. The
estimated cost per QALY and the relative incremental-cost-effectiveness ratio (ICER) for AMIC is more favourable than MACI
(according to the UK and US standard). AMIC was shown to be more cost effective than MACI in this analysis.

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