Table 4 Results of completed economic evaluations

Results from model-based economic evaluations

 Results from CEAs

  Dholakia 2021 [41]

Mortality: 397/4415 (9.0%) vs. 441/4415 (10.0%); RD^b -1.0%

Mean 59,849 vs. 65,304; MD^b -5455

Cost-effective

ISPOR-Q: Insufficiently credible

 Results from CBAs

  Chen 2022 [40]

Morbidity: 24/240 (10.0%) vs. 16/240 (6.7%); RD^b -3.3%

Mean^b 3292 vs. 3742; MD^b -450

Cost-effective; total cost–benefit: 108,022 EUR (2020)

ISPOR-Q: Sufficiently credible

  Van Wijk 2020 [54]

Morbidity: not reported

28,001 vs. 30,242; difference -2,241^c

Unclear (effectiveness not reported); return of investment: 1.55

ISPOR-Q: Insufficient information

Results from trial-based economic evaluations

 Results from CUAs

  AlShewaier 2016 [37]

QALYs^d: Median 0.679 (IQR 0.10) vs. 0.573 (0.05); Difference in medians^b 0.106

Median 20,790 vs. 19,952; difference in medians^b 838

Unclear; incremental analysis required: ICER: 7906 EUR (2020) per QALY gained, but no WTP reported

RoB 2: High

CHEC: 13/19 items

  Fernandes 2017 [42]

QALYs^d: Mean 0.66 ± BS SE 0.04 vs. 0.61 ± 0.04^e; MD 0.04 (95% CI 0.01 to 0.07)

Mean 17,432 ± BS SE 1265 vs. 17,574 ± 1480; MD -142 (95% CI -3952 to 3668) (331^b when including patient expenses)

Cost-effective (unclear when including patient expenses); Probability of CEA at a WTP of 40,000 EUR: 84% (approx. 79% when including patient expenses)

RoB 2: Some concerns

CHEC: 16/19 items

  Nguyen 2022

QALYs^d: Mean 0.7 ± SD 0.3 vs. 0.6 ± 0.3; MD^b 0.1

Mean 15,071 ± SD 7014 vs. 15,472 ± 6309; MD -401

Cost-effective

RoB: Some concerns (QALY), high (costs)

CHEC: 9/19 items

  Tveter 2020 [53]

QALYs^d: Not reported per group; difference 0.07^c

Not reported per group; difference -508^c

Cost-effective

RoB 2: Some concerns (QALY), high (costs)

CHEC: 11/19 items

 Results from CEAs

  McGregor 2004 [47]

HrQoL: EQ-5D-3L VAS (0–100%)^d: mean 75.80 ± SD 14.86 vs. 72.15 ± 22.20^f; MD^b 3.65%, EQ-5D-3L utilities^d: mean 0.72 ± SD 0.13 vs. 0.60 ± SD 0.31^f; MD^b 0.12

Mean 4148 vs. 5005; MD^b -856

Cost-effective

RoB 2: High

CHEC: 8/19 items

  Tew 2017 [52]

HrQoL: EQ-5D-5L utilities^d: mean 0.837 vs. 0.760; MD 0.077 (95% CI 0.005 to 0.148)

BS mean 14,269 ± SD 3542 vs. 13,688 ± 3542; BS MD 582 (95% CI -1588 to 2848)

Unclear; incremental analysis required, but ICER not reported

RoB 2: High

CHEC: 14/19 items

 Results from CCAs

  Barberan-Garcia 2019 [38]

HrQoL:

SF-36 PCS^d: mean 47 ± SD 7 vs. 44 ± 8; MD^b 3

SF-36 MCS score^d: mean 51 ± SD 9 vs. 50 ± 9; MD^b 1

Morbidity: 19/62 (30.6%) vs. 39/63 (61.9%); RD^b -31.3%

Mortality: 1/62 (1.6%) vs. 4/63 (6.3%); RD^b -4.7%

PROMs:

YPAS score^d: mean 46 ± SD 13 vs. 39 ± 15; MD^b 7

HAD total score: mean 6 ± SD 5 vs. 8 ± 6; MD^b -2

Mean 5428 (range 1792 to 30,532) vs. 6416 (1587 to 34,521); BS MD -955 (95% CI -3109 to 1033)

Cost-effective

RoB 2: Some concerns (morbidity, mortality), high (PROMs, costs)

CHEC: not applicable

  Gao 2015 [43]

Morbidity: 12/71 (16.9%) vs. 59/71 (83.3%); RD^b -66.4%

Mean 9728 ± SD 1130 vs. 8955 ± 888; MD^b 773

Unclear; incremental analysis required, but ICER not applicable for CCA

ROBINS-I: Serious

CHEC: not applicable

  Gränicher 2020 [44]

PROMs:

Lysholm Score^d: mean 87.1 ± SD 9.0 vs. 69.1 ± 14.9; MD^b 18

Lysholm Score pain item^d: mean 25.0 ± SD 0.0 vs. 16.5 ± 9.1; MD^b 8.5

Tegner Activity Scale^d: mean 3.8 ± SD 0.8 vs. 2.5 ± 0.9; MD^b 1.3

Physical function:

Stair climbing test, time in seconds: mean 12.58 ± SD 4.64 vs. 13.59 ± 5.30; MD^b -1.01

Knee ROM (degrees)^d: mean 100.5 ± SD 18.7 vs. 103.5 13.7; MD^b -3

Mean 3187 vs. 4052; MD^b -865

Unclear (inconsistent effectiveness); individual decision required

RoB 2: Some concerns (PROMs, physical function), high (costs)

CHEC: not applicable

  Howard 2019 [30]

Morbidity: 12/40 (30.0%) vs. 29/75 (38.7%); RD^b -8.7%

Mortality: 1/40 (2.5%) vs. 1/75 (1.3%); RD^b 1.2%

Mean 58,300 ± SD 42,590 vs. 75,248 ± 77,516; MD^b (incorporating prehabilitation costs) -16,870

Unclear (inconsistent effectiveness); individual decision required

ROBINS-I: Serious

CHEC: not applicable

  Huang 2012 [45]

Morbidity:

Infection rate: 2/126 (1.6%) vs. 1/117 (0.9%); RD^b 0.7%

Rate of deep vein thrombosis: 5/126 (4.0%) vs. 3/117 (2.6%); RD^b 1.4%

PROMs: Pain (VAS): mean 2.4 ± SD 0.7 vs. 2.5 ± 0.6; MD^b -0.1

Physical function:

Knee ROM (degrees)^d: mean 76 ± SD 22 vs. 74 ± 20; MD^b 2

Ambulation status^d: 108/126 (85.7%) vs. 95/117 (81.2%); RD^b 4.5%

Mean 6726 ± SD 283 vs. 6841 ± SD 241; MD^b (incorporating prehabilitation costs) -95

Unclear (inconsistent effectiveness); individual decision required

RoB 2: High

CHEC: not applicable

  Koh 2021 [46, 86]

Morbidity: 24/58 (41.4%) vs. 11/23 (47.8%); RD^b -6.4%

Mortality^g: 0/58 (0%) vs. 0/23 (0%); RD^b 0%

Not reported per group; MD -2584

Cost-effective

ROBINS-I: Serious

CHEC: not applicable

  Lai 2017 [32]

Morbidity: 5/51 (9.8%) vs. 14/50 (28.0%); RD^b -18.2%

Mean 7677 ± SD 1374 vs. 8608 ± 2482; MD^b -931

Cost-effective

RoB 2: High

CHEC: not applicable

  Lai 2019 [33]

Morbidity: 4/34 (11.8%) vs. 12/34 (35.3%); RD^b -23.5%

Median 10,456 (IQR 9683 to 11,339) vs. 11,285 (10,544 to 13,340); Difference in medians^b -830

Cost-effective

RoB 2: High

CHEC: not applicable

  Ploussard 2020 [50]

Mortality: 0/194 (0%) vs. 1/156 (0.6%); RD^b -0.6%

Mean 2904 vs. 3282; MD^b -379

Cost-effective

ROBINS-I: Serious

CHEC: not applicable

  Risco 2022 [51]

Morbidity: Comprehensive complications index: mean 15.1 ± SD 17.1 vs. 16.6 ± 16.9; MD^b: -1.5

Mean 7288 vs. 7142; MD 145

Unclear; incremental analysis required, but ICER not applicable for CCA

ROBINS-I: Serious

CHEC: not applicable

  Wang 2020 [55]

Morbidity: 21/70 (30.0%) vs. 18/34 (52.9%); RD -22.9%

Mortality: 1/70 (1.4%) vs. 1/34 (2.9%); RD^b -1.5%

PROMs (in subsample of n = 33 vs. n = 24):

FACT-Hep score^d: median 152 (range 102 to 179) vs. 148 (66 to 175); differences in medians^b 4

Median 6138 (IQR 4590 to 8833) vs. 7349 (5328 to 11,026); difference in medians -1210

Cost-effective

ROBINS-I: Serious

CHEC: not applicable

  Zhou 2017 [34]

Morbidity: 36/197 (18.3%) vs. 194/742 (26.1%); RD^b: -7.8%

Not calculable in EUR (2020) as original currency not reported; original values: mean 7131.8 ± SD 2316.6 vs. 77,266.4 ± 1615.0; MD^b -134.60

Cost-effective

ROBINS-I: Critical

CHEC: not applicable

 Results from CMAs

  Beaupre 2004 [39]

Not applicable

Mean 1285 ± SD 1196 vs. 1283 ± 1329; MD 2

Not cost-effective

RoB 2: High

CHEC: not applicable

  Englesbe 2017 [29]

Not applicable

Provider perspective: median 16,900 (IQR 10,162 to 30,365) vs. 23,091 (14,993 to 39,017); difference in medians^b -6191

Payer perspective: median 19,216 (IQR 12,122 to 33,840) vs. 24,519 (17,057 to 37,243); difference in medians^b -5303

Cost-effective

ROBINS-I: Serious

CHEC: not applicable

  Mouch 2019 [31]

Not applicable

Mean 24,435 ± SD 20,024 vs. 26,903 ± 24,935; MD^b -2468

Cost-effective

ROBINS-I: Moderate

CHEC: not applicable

  Pham 2016 [49]

Not applicable

Reported only for a subset of patients (5/29 vs. 11/21): mean 5081 ± SD 298 vs. 5152 ± 656; MD^b -71

Cost-effective

RoB 2: High

CHEC: not applicable