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Rationing of total knee replacement: a cost-effectiveness analysis on a large trial data set
  1. Helen Dakin1,
  2. Alastair Gray1,
  3. Ray Fitzpatrick2,
  4. Graeme MacLennan3,
  5. David Murray4,
  6. The KAT Trial Group
  1. 1Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford, UK
  2. 2Department of Public Health, University of Oxford, Oxford, UK
  3. 3Health Services Research Unit, University of Aberdeen, Aberdeen, UK
  4. 4Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Helen Dakin; helen.dakin{at}dph.ox.ac.uk

Footnotes

  • Protocol: Available at http://www.hta.ac.uk/protocols/199500100001.pdf

  • To cite: Dakin H, Gray A, Fitzpatrick R, et al. Rationing of total knee replacement: a cost-effectiveness analysis on a large trial data set. BMJ Open 2012;2:e000332. doi:10.1136/bmjopen-2011-000332

  • Funding The Knee Arthroplasty Trial is funded by the NIHR Health Technology Assessment Programme (project number 95/10/01). Additional funding for research support in clinical centres was provided by Howmedica Osteonics; Zimmer; DePuy, a Johnson and Johnson company; Corin Medical; Smith and Nephew Healthcare; Biomet Merck and Wright Cremascoli. The Health Economics Research Centre obtains support from the National Institute of Health Research. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health Directorates. The Biomedical Research Unit at Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences is funded by the National Institute of Health Research. The authors conducted the research independently of all funding organisations. The funders had no role in the collection, analysis or interpretation of data, writing of the manuscript or the decision to publish. The authors had full access to all the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no support from any organisation for the submitted work with the exception of those declared in the funding statement. AG, RF and GM declare that they have no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work. DM receives royalties paid to him by Biomet but both declare that they have no other financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval The KAT trial was approved by the Multi Centre Research Ethics Committee for Scotland in November 1998 (research protocol MREC/98/0/100) and was approved by the Local Research Ethics Committees in each study centre recruiting trial participants. Further details are available on request.

  • Contributors HD, AG and DM conceived and developed the principles and methods underpinning the current analysis. GM was involved in primary data collection and database management, while HD conducted the analysis under AG's supervision and guidance from DM, GM and RF. HD drafted the manuscript with input from all other authors; all authors have approved the final manuscript and were involved in the interpretation of results. The KAT trial was conceived, designed and run by the KAT trial group, which comprised Suzanne Breeman, Marion Campbell, HD, Jackie Ellington, Nick Fiddian, RF, Adrian Grant, AG, Linda Johnston, GM, Richard Morris and DM.

  • Data sharing statement See http://bmjopen.bmj.com/site/about/resources/datamanagement.xhtml.

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Footnotes

  • Protocol: Available at http://www.hta.ac.uk/protocols/199500100001.pdf

  • To cite: Dakin H, Gray A, Fitzpatrick R, et al. Rationing of total knee replacement: a cost-effectiveness analysis on a large trial data set. BMJ Open 2012;2:e000332. doi:10.1136/bmjopen-2011-000332

  • Funding The Knee Arthroplasty Trial is funded by the NIHR Health Technology Assessment Programme (project number 95/10/01). Additional funding for research support in clinical centres was provided by Howmedica Osteonics; Zimmer; DePuy, a Johnson and Johnson company; Corin Medical; Smith and Nephew Healthcare; Biomet Merck and Wright Cremascoli. The Health Economics Research Centre obtains support from the National Institute of Health Research. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health Directorates. The Biomedical Research Unit at Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences is funded by the National Institute of Health Research. The authors conducted the research independently of all funding organisations. The funders had no role in the collection, analysis or interpretation of data, writing of the manuscript or the decision to publish. The authors had full access to all the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no support from any organisation for the submitted work with the exception of those declared in the funding statement. AG, RF and GM declare that they have no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work. DM receives royalties paid to him by Biomet but both declare that they have no other financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval The KAT trial was approved by the Multi Centre Research Ethics Committee for Scotland in November 1998 (research protocol MREC/98/0/100) and was approved by the Local Research Ethics Committees in each study centre recruiting trial participants. Further details are available on request.

  • Contributors HD, AG and DM conceived and developed the principles and methods underpinning the current analysis. GM was involved in primary data collection and database management, while HD conducted the analysis under AG's supervision and guidance from DM, GM and RF. HD drafted the manuscript with input from all other authors; all authors have approved the final manuscript and were involved in the interpretation of results. The KAT trial was conceived, designed and run by the KAT trial group, which comprised Suzanne Breeman, Marion Campbell, HD, Jackie Ellington, Nick Fiddian, RF, Adrian Grant, AG, Linda Johnston, GM, Richard Morris and DM.

  • Data sharing statement See http://bmjopen.bmj.com/site/about/resources/datamanagement.xhtml.

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