Optimized Multisurface Osteochondral Allograft Transplantation and Unicompartmental Knee Arthroplasty Are Associated With Potential Advantages in Direct Comparative Cost‐Effectiveness Over Total Knee Arthroplasty in a 30‐Year Economic Analysis Model of Active Middle‐Aged Patients With Complex Articular Disorders of the Knee

Purpose To perform comparative cost‐effectiveness assessments through 30‐year follow‐up after multisurface osteochondral allograft transplantation (mOCAT), unicompartmental knee arthroplasty (UKA), or total knee arthroplasty (TKA) in a theoretical cohort of middle‐aged patients with symptomatic complex articular disorders in the knee. Methods A Markov cohort model was designed and used to evaluate the comparative cost‐effectiveness of mOCAT, UKA, and TKA over a 30‐year follow‐up period in a theoretical patient population of active 40‐year‐olds based on quality‐adjusted life year, incremental cost‐effectiveness ratio, and willingness‐to‐pay analyses. Results Among all surgical procedures analyzed, mOCAT was associated with the highest costs ($111,721 at 30 years), whereas UKA was associated with the lowest costs ($31,072 at 30 years). UKA was determined to be the most cost‐effective of all procedures analyzed when comparing direct costs based on incremental cost‐effectiveness ratio using a willingness‐to‐pay threshold of $50,000. Despite the relatively high direct costs, optimized mOCAT yielded the greatest benefits relative to TKA with respect to cumulative quality‐adjusted life year differences throughout the study period modeled, indicating a sustained and clinically meaningful benefit. In addition, optimized mOCAT showed a clinically meaningful improvement over UKA in exceeding the cumulative minimal clinically important difference threshold, but only during the first 10 years after surgery. Sex‐stratified analyses showed minor differences in incremental cost‐effectiveness ratio estimates between men and women, but the overall cost‐effectiveness conclusions remained unchanged. Conclusions The results of this study provide computational data in support of optimized mOCAT and UKA being associated with potential advantages in direct comparative cost‐effectiveness over TKA in a 30‐year economic analysis model for a theoretical population of active middle‐aged patients with complex articular disorders of the knee. Level of Evidence Level IV, economic analysis.