Original Title: Artroscopia con lavado articular en el tratamiento de la artrosis de rodilla

Authors' objectives: To do a summary of safety and efficacy scientific evidence related with knee arthroscopy in the treatment of knee arthrosis. As well as, to do a cost analysis of the afore mentioned surgical technique.

Authors' results and conclusions: National and International CPG have been located and after the quality evaluation using AGREE II, it has been demonstrated that the procedure is not effective in acute or chronic processes of knee arthrosis except in cases of mechanical locking. The unitary cost of an arthroscopy with joint washout for year 2013 was of 1,773 €, being the total cost in the Autonomous Community of the Basque Country of 72,689 € and in the National Health System of 381,171 €. In case 1 scenario the unitary cost of an arthroscopy with joint washout is 1,660 € and in scenario 2 is 1,551 €. The univariate sensitivity analysis, represented by a Tornado Diagram, shows the number of Nursing Graduates and the time they spend in the procedure as the variables that influence the most, in spite having a low impact in the result of the unitary cost of an arthroscopy with joint washout in the treatment of knee arthrosis in the three studied scenarios. Finally the variability analysis shows that the number of interventions done in the period 2007 – 2009 is not high (< 2000), even though a high variability between the studied areas is observed. CONCLUSIONS The collected evidence demonstrates that the studied procedure is not effective, except for the cases of mechanical locking. The impact of the resources to be released by eliminating the procedure “Arthroscopy with joint wash in knee arthrosis” would not be very high. But taking into account that it offers neither medium nor long term benefit, these resources could be employed in other kinds of care that would be more beneficial for the population. Variability shown in the National Health System (NHS) defines sanitary areas where an intervention in disinvestment would be convenient in order to guarantee a better use of the existing resources.

Authors' methods: A bibliographic search until October 2014 in MEDLINE (Pubmed), EMBASE, CINAHL, The Cochrane Library, Tripdatabase, DARE y HTA has been done. Bibliographic quotes of relevant studies have also been reviewed in order to locate new articles. The NGC (National Guideline Clearinghouse) page has also been reviewed in order to identify Clinical Practice Guidelines as well as the CRD database of the NHS-EED in order to identify economic studies. A search of Pubmed and EMBASE was also carried out with the same purpose. A cost analysis from the point of view of the Basque Health System was performed, evaluating the direct costs of this technique. Three scenarios are taken into account, based on the perishable materials used in the intervention: Base scenario (Including motor and vaporizer costs), scenario 1 (vaporizer cost) and scenario 2 (motor cost). A univariate sensitivity analysis of the variables that generate doubts is made through the graphic representation of a Tornado Diagram. Likewise, a variability analysis of the use of this therapeutic procedure between health areas and on each Autonomous Community was carried through.

Project Status: Completed

Year Published: 2015

URL for published report: https://www.ogasun.ejgv.euskadi.eus/r51-catpub/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=051729&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>