OBJECTIVES: Knee osteoarthritis is one of the most common joint diseases in the world. The rate of total knee replacement (TKR) has more than doubled over the last fifteen years in France (166.8 TKRs per 100,000 population in 2016) despite the most recent guidelines that recommend TKR as the last option if all other treatments have failed. The two aims of this study were to determine the costs for French patients undergoing TKR due to knee osteoarthritis and to estimate the potential cost savings from the point of view of the French social health insurer if the number of total knee replacements were reduced.

METHODS: The 2018 national hospital database (PMSI) was used to establish annual costs of patients undergoing TKR due to knee osteoarthritis in France. We carried out a one-year budget impact analysis to determine the savings incurred if TKRs were reduced by 8% based on lowering the rate of surgeries to match the OECD average. Alternative intervention to surgery was a combination of pharmacological and non-pharmacological treatments and the costs for the alternative interventions were estimated using French tariffs (€, 2018).

RESULTS: In 2018, 96,467 French patients had a TKR due to knee osteoarthritis. Their mean age was 70.6 years and 60% were females. The average cost of a TKR was €6,555 per patient and total annual cost was €632,314,517. Cost savings accounted for €48 million when the number of TKRs performed were reduced.

CONCLUSIONS: This analysis provides real world data on the potential cost savings if total knee replacements are decreased in France. Given the available evidence on the minimal QALY losses that occur when restricting TKRs, a better allocation of resources could liberate funds for more cost-effective interventions.