Costs and models used in the economic analysis of Total Knee Replacement (TKR): A systematic review

Naline Gandhi; Amatullah Sana Qadeer; Ananda Meher; Jennifer Rachel; Abhilash Patra; Jebamalar John; Aiswarya Anilkumar; Ambarish Dutta; Lipika Nanda; Sarit Kumar Rout

doi:10.1371/journal.pone.0280371

Peer Review History

Original SubmissionDecember 27, 2022
22 May 2023 Decision Letter - Meng Li, Editor PONE-D-22-35337Costs and models used in the economic analysis of Total Knee Replacement (TKR): A Systematic ReviewPLOS ONE Dear Dr. Rout, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jul 06 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. 2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 3. We note that the manuscript is reporting a meta-analysis on genetic association studies. We need you to provide us with additional information in relation to this meta-analysis; please complete the following checklist and upload it as a Supporting Information file with a file name “GAMA checklist”. The checklist can be downloaded here: http://www.plos.org/wp-content/uploads/2013/05/meta-analysis-on-genetic-association-studies-form.docx. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: - The study on ‘costs and models used in the economic analysis of Total Knee Replacement (TKR) – a systematic review’ is simple, clear and to the point. It is useful in devising best model for cost effectiveness that can be utilized in further studies. The review also highlights the point that low- and middle-income countries despite having limited number of studies also have lowest cost of TKR surgery. The cost extraction through PPP method is helpful in identifying the best medical tourism for TKR across different countries of the world. - References 7 and 9 are the same, repeated. Reviewer #2: 1. The study overall is well-structured and clearly written. 2. Google Scholar was not mentioned as a resource for literature in the methodology and abstract sections but appeared in the results section. 3. The discussions regarding the Markov model (Lines 334-342) were general and focused on the characteristics of the model. It would have been beneficial to have a more comprehensive discussion, specifically addressing why the Markov model is more applicable or appropriate for TKR. 4. The definition of direct and indirect costs needs clarification. For example, in Line 257, the authors mentioned "cost of travel." If this refers to transportation costs covered by health insurance, it might fall under direct non-medical costs. It would be helpful to explain this in more detail, perhaps by providing a brief explanation in the text or adding footnotes to Table 1. 5. The section pertaining to the cost data for TKR surgery is somewhat ambiguous (Line 288-296). Could you please clarify the reporting process for the cost of TKR surgery in this section? It's unclear if ancillary costs were factored into the reported cost or if it is strictly focused on the surgical expenses. Also, does the reported cost represent the price per surgery? Your clarification would greatly enhance our understanding of the data. 6. In Line 320-322, you mentioned that "The TKR surgery is also a cost-effective method of treatment for OA knee compared to non-surgical management across the world, which mostly consists of studies from developed countries." This statement might be misleading to readers. It is important to clarify that this statement reflects findings from existing research rather than a conclusion drawn from your own study. Consider revising it to: "Previous literature reviews indicated that TKR surgery is often considered a cost-effective treatment method for OA knee compared to non-surgical management, primarily based on studies conducted in developed countries worldwide." 7. Needs some adjustments and format change for improved consistency, clarity and readability (1) Figure 1, particularly the "Reports not retrieved" section is incomplete. (2) Several typo errors and instances of missing punctuation have been noticed, such as in Line 324. Kindly make the necessary corrections. (3) For Figure 2, it is recommended to use the currency format ($##,###). 8. Did you consult with a librarian to develop your search terms? If so, please mention in your methods. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Dr. Madhuri Latha Devaraju Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0280371.r001
Revision 1
26 Jun 2023 Author Response Dear Editor, I, on behalf of all the authors would like to thank you for your valuable comments and suggestions, which gave us the opportunity to improve the paper. In the revised manuscript, we have addressed all the issues raised. Moreover, in this document, I provide point by point response to queries raised by the journal. Comments are shown in bold font, followed by our answer/comment in normal font. The major corrections/changes in the manuscript are displayed in red font. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. We have revised the manuscript to meet PLOS ONE’s style requirements, including file naming according to the templates provided 2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. We have clarified in detail, the fund receipt process for developing the manuscript. Department of health research (DHR), MoHFW, Government of India, has signed a MoU with IIPH Hyderabad to establish a regional resource center for conducting Health technology assessment (HTA). This resource center as a part of its ongoing research conducted this literature review. The staff engaged in this activity were funded by the DHR. 3. We note that the manuscript is reporting a meta-analysis on genetic association studies. We need you to provide us with additional information in relation to this meta-analysis; please complete the following checklist and upload it as a Supporting Information file with a file name “GAMA checklist”. The checklist can be downloaded here: http://www.plos.org/wp-content/uploads/2013/05/meta-analysis-on-genetic-association-studies-form.docx. The manuscript does not have a meta-analysis component, nor does it report on genetic studies. Hence, a GAMA checklist is not applicable to our study. Reviewer #1: The study on ‘costs and models used in the economic analysis of Total Knee Replacement (TKR) – a systematic review’ is simple, clear and to the point. It is useful in devising best model for cost effectiveness that can be utilized in further studies. The review also highlights the point that low- and middle-income countries despite having limited number of studies also have lowest cost of TKR surgery. The cost extraction through PPP method is helpful in identifying the best medical tourism for TKR across different countries of the world. 1. References 7 and 9 are the same, repeated. Thank you very much for your detailed observation and we have made the necessary changes in the manuscript. Reviewer #2: 1. The study overall is well-structured and clearly written. 2. Google Scholar was not mentioned as a resource for literature in the methodology and abstract sections but appeared in the results section. We have changed as per the suggestions in all the sections. 3. The discussions regarding the Markov model (Lines 334-342) were general and focused on the characteristics of the model. It would have been beneficial to have a more comprehensive discussion, specifically addressing why the Markov model is more applicable or appropriate for TKR. This is an important observation and in the revised manuscript, we have explicitly mentioned the merits of Markov model as this captures different health states when a person can move from one state to other and again reverses. When TKR surgery is done, the patient may transition from bad to good and further may return to a worse situation, Markov Model captures all these transitions and provides their ICER values. We have elaborated on this in Lines 353-371. 4. The definition of direct and indirect costs needs clarification. For example, in Line 257, the authors mentioned "cost of travel." If this refers to transportation costs covered by health insurance, it might fall under direct non-medical costs. It would be helpful to explain this in more detail, perhaps by providing a brief explanation in the text or adding footnotes to Table 1. We have clarified the definition of direct and indirect cost in Lines (261-264) as used by the manuscript under review. Importantly, direct cost includes cost of medicine, diagnostic services, cost of implant, doctor’s fee and other hospitalization related expenditure, and non-medical cost such as cost of food, travel related to hospital access. Indirect cost includes —income loss due to TKR and income loss of caretaker of the patient. 5. The section pertaining to the cost data for TKR surgery is somewhat ambiguous (Line 288-296). Could you please clarify the reporting process for the cost of TKR surgery in this section? It's unclear if ancillary costs were factored into the reported cost or if it is strictly focused on the surgical expenses. Also, does the reported cost represent the price per surgery? Your clarification would greatly enhance our understanding of the data. We have added details on data collection of costs in Lines (299-302). Moreover, studies that collected costs from national database and secondary literature are cited as well. 6. In Line 320-322, you mentioned that "The TKR surgery is also a cost-effective method of treatment for OA knee compared to non-surgical management across the world, which mostly consists of studies from developed countries." This statement might be misleading to readers. It is important to clarify that this statement reflects findings from existing research rather than a conclusion drawn from your own study. Consider revising it to: "Previous literature reviews indicated that TKR surgery is often considered a cost-effective treatment method for OA knee compared to non-surgical management, primarily based on studies conducted in developed countries worldwide." We have revised it to “Our literature review suggests that TKR surgery is often considered a cost-effective treatment method for OA knee compared to the non-surgical management, primarily based on studies conducted in the developed countries” 7. Needs some adjustments and format change for improved consistency, clarity and readability (1) Figure 1, particularly the "Reports not retrieved" section is incomplete. (2) Several typo errors and instances of missing punctuation have been noticed, such as in Line 324. Kindly make the necessary corrections. (3) For Figure 2, it is recommended to use the currency format ($##,###). Thank you for the suggestions. The changes have been incorporated accordingly. 8. Did you consult with a librarian to develop your search terms? If so, please mention in your methods. We did not consult a librarian during the development of search terms or at any point of the review. Attachments Attachment Submitted filename: Response to Reviewer.docx https://doi.org/10.1371/journal.pone.0280371.r002
13 Jul 2023 Decision Letter - Meng Li, Editor Costs and models used in the economic analysis of Total Knee Replacement (TKR): A Systematic Review PONE-D-22-35337R1 Dear Dr. Rout, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Meng Li Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Madhuri Devaraju ******** https://doi.org/10.1371/journal.pone.0280371.r003
Formally Accepted
17 Jul 2023 Acceptance Letter - Meng Li, Editor PONE-D-22-35337R1 Costs and models used in the economic analysis of Total Knee Replacement (TKR): A Systematic Review Dear Dr. Rout: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Meng Li Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0280371.r004

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