Treating Hepatitis C Before Total Knee Arthroplasty is Cost-Effective: A Markov Analysis

Introduction Patients who have the hepatitis C virus (HCV) have increased mortality and complication rates following total knee arthroplasty (TKA). Recent advances in HCV therapy have enabled clinicians to eradicate disease using direct acting antivirals (DAA), however, its cost-effectiveness prior to TKA remains to be demonstrated. The aim of this study was to perform a cost-effectiveness analysis comparing no therapy to direct-acting antivirals (DAA) prior to TKA. Methods A Markov model using input values from the published literature was performed to evaluate the cost-effectiveness of DAA treatment prior to TKA. Input values included event probabilities, mortality, cost, and health state quality-adjusted life-year (QALY) values for patients who have and do not have HCV. Patients who have HCV were modeled to have an increased rate of PJI infection (9.9 to 0.7%). The incremental cost-effectiveness ratio (ICER) of no therapy versus DAA was compared to a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to investigate the effects of uncertainty associated with input variables. Results Total knee arthroplasty in the setting of no therapy and DAA added 8.1 and 13.5 QALYs at a cost of $25,000 and $114,900. The ICER associated with DAA in comparison to no therapy was $16,800/QALY, below the willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses demonstrated that the ICER was affected by patient age, inflation rate, DAA cost and effectiveness, HCV-associated mortality, and DAA-induced reduction in periprosthetic joint infection rate. Conclusion Direct-acting-antiviral treatment prior to TKA reduces risk of PJI and is cost-effective. Strong consideration should be given to treating patients who have HCV prior to elective TKA.