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Knee op restrictions are ‘a false economy’

Knee replacement surgery is highly cost-effective and any rationing by PCTs or clinical commissioning groups based on the severity of symptoms is ‘probably unjustified', UK researchers conclude.

GPs have faced increasing restrictions on referrals for knee replacement surgery, but researchers looking at the post-surgery outcomes of 2,131 osteoarthritis patients found the procedure represented ‘very good value for money'.

The study, published online by BMJ Open, calculated the costs of surgery and subsequent NHS care per patient over five years, and compared this with the change in outcomes.

Patients gained an average of 1.33 quality-adjusted life years (QALY), at an average cost of £7,458 per patient. This equated to a cost per QALY of £5,623 per year – well below the cost-effectiveness threshold of £20-30,000 usually employed by NICE.

Body mass index did not have a significant effect on either cost or outcomes and costs rose the more surgery was delayed, prompting the authors to conclude that restricting surgery only to those with worse symptoms was a ‘false economy'.

PCTs have introduced a series of controversial restrictions on knee replacement surgery, including bans on patients with less severe symptoms as measured by the Oxford Knee Score, and a CCG in Hertfordshire came under fire last year after Pulse revealed it had banned surgery for patients with a BMI over 30.

Study leader Dr Helen Dakin, senior researcher at the University of Oxford's health economics research centre, said: ‘The results demonstrate that the thresholds proposed by some PCTs are inappropriate and would deny a highly cost-effective treatment to thousands of patients.'

Dr Louise Warburton, a GPSI in musculoskeletal medicine in Shrewsbury and president of the Primary Care Rheumatology Society, said PCT rationing in her area had been successfully challenged: ‘Local GPs opposed it so strongly on lack of evidence grounds that it was thrown out.'