Cell-Based Therapies Reduce Costs and Knee Replacement Surgeries and Increase QALYs Among Knee Osteoarthritis Patients in the Netherlands: A Cost-Effectiveness Study

OBJECTIVES: Osteoarthritis (OA) is a leading cause of disability worldwide, resulting in pain, structural changes in the bone and joint space, and limitation of motion. Current treatments are designed to reduce pain and improve the mobility of joints instead of promoting the regeneration of damaged articular cartilage. Cell and cell-based therapies are being developed for the treatment of OA by the Horizon2020 project Automated Cellular Robot-Assisted Technologies for translation of discovery-led research in Osteoarthritis (AutoCRAT). The aim of this study was to assess the cost-effectiveness of AutoCRAT’s mesenchymal stromal cells (MSC) and extracellular vesicles (EV) treatments compared to standard of care (SoC) for patients with Kellgren-Lawrence (KL) stage II knee OA in the Netherlands over a period of 40 years, from a societal perspective.

METHODS: A Markov model with 8 health states was developed to assess the incremental cost effectiveness ratio (ICER) over 40 years of automated or manually produced MSC or EV cells compared to SoC. Secondary outcomes were amount of total knee replacement (TKR) and TKR revision (TKRR) surgeries over 40 years. One-way sensitivity analyses were performed to determine the main cost drivers.

RESULTS: This study shows ICERs of -€68,870.58 per QALY for automatically produced MSC treatment, -€67,280.27 for manually produces MSC treatment, -€70,771.65 for automatically produced EV treatment, and -€69,976.50 for manually produced EV treatment compared to SoC. The amount of TKR surgeries per 1,000 patients over 40 years was 426 for the cell treatment groups, and 609 for the SoC group, and 19 and 30 TKRR surgeries, respectively.

CONCLUSIONS: This study shows that AutoCRAT's cell treatments are expected to be cheaper and more effective for patients with knee OA KL stage II in The Netherlands. Besides, they are expected to lower the amount of TKR and TKRR surgeries.