Fig 1.
Model Structure for the Treatment of Meniscal Tear.
Fig 1 describes the model structure used for evaluating the cost-effectiveness of three strategies used for the treatment of MT in the presence of knee OA: 1) PT, 2) PT with referral for APM in those patients with persistent pain after PT, and 3) APM for all patients. Straight arrows describe a subject’s transition from one health state to another. Curved arrows indicate the possibility of cycling within one health state given no change in pain status. Health states were stratified by KL grade. Subjects who received a particular treatment transitioned through early and late, and low or moderate pain states depending on treatment efficacy and knee OA progression. All subjects in the ‘Delayed APM’ strategy who transitioned to early moderate pain transitioned to APM with probability of 1. Subjects in late pain could transition to TKA.
Table 1.
Base Case Parameters.
Fig 2.
Percentage of Subjects in Moderate Pain, Stratified by Treatment Arm.
Fig 2 describes the percentage of subjects reporting pain within each of the evaluated three treatment strategies over the course of 10 years. Two trajectories are reported for the Delayed APM strategy, represented in black and gray dashed lines in the graph. The black dashed Delayed APM trajectory reflects the base case, where the surgery’s efficacy was calculated based on results reported by MeTeOR subjects who crossed over from the non-operative to the operative arm between months 3 and 6. The gray dashed ‘Delayed APM’ line reflects the sensitivity analysis of Delayed APM, where we assumed the efficacy of a delayed surgery following a failed PT regimen would be equal to that of an APM procedure immediately following a MT diagnosis.
Table 2.
Cost-effectiveness of Management Strategies for Meniscal Tear, with Sensitivity Analyses.
Fig 3.
Cost-Effectiveness Acceptability Curve.
Fig 3 shows the proportion of iterations where a given strategy proved to be the most cost-effective (i.e., the strategy with the highest NMB whose ICER was below the WTP threshold), represented by the y-axis, given a specific WTP, represented by the x-axis. Time costs were not included.
Fig 4.
Cost-effectiveness Acceptability Frontier and Expected Value of Perfect Information.
Fig 4 contains two categories of reported results. The first is the cost-effectiveness acceptability frontier, described by solid gray and black lines at the top half of the graph. The frontier describes the likelihood that the strategy with highest NMB at any given WTP threshold is cost-effective, where likelihood is defined as a probability on the left-most Y axis. NMB is calculated by subtracting the cost of a treatment strategy from the product of a strategy’s effectiveness and a given WTP. The bottom half of the graph describes the EVPI reported for each WTP threshold for the strategy defined as preferred under that threshold. EVPI results are represented by dotted lines in dollars per person by the right-side Y axis. Time costs were not included.