Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis

Luxme Mahendira,Caroline Jones,Laurence Rubin,James Waddell,Angelo Papachristos

doi:10.1007/s00264-019-04405-y

Luxme Mahendira, Caroline Jones + Show 3 more

Open Access

https://doi.org/10.1007/s00264-019-04405-y

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Abstract

ObjectiveTo evaluate the management and costs of osteoarthritis of the knee (OAK), a progressive joint disease due to bone and cartilage degeneration, with significant personal and societal impact.MethodsWe prospectively analyzed the clinical outcomes and quantifiable cumulative direct costs of patients with OAK referred to our multidisciplinary OA program over a two year time period. One hundred thirty-one subjects were assessed. All demonstrated radiographic criteria for moderate to severe OAK. Western Ontario McMaster Osteoarthritis Index (WOMAC), Minimal Clinically Important Improvement (MCII), and change in BMI were recorded and analyzed. Total medical and surgical direct costs for all subjects during the two year time period were determined.ResultsFive patients underwent total joint replacement during the two years of study. Among the group as a whole, a significant overall improvement in WOMAC scores was noted at the two year time point follow-up. After dividing the group into tertiles by baseline WOMAC scores, 46% achieved MCII. Significant weight loss was noted for individuals with baseline BMI of > 30. As all patients were considered “de facto” surgical candidates at referral, an average net savings of $9551.10 of direct costs per patient, or a potential total of $1,203,438.60 for the entire group, could be inferred as a result of medical as opposed to surgical management.ConclusionThese findings support the benefits of multidisciplinary medical management for patients with significant OAK. This approach is clinically beneficial and may provide significant cost savings. Such models of care can substantially improve the long-term outcome of this highly prevalent condition and reduce societal and financial burdens.

Highlights

Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Osteoarthritis (OA) is a progressive joint disease due to bone and cartilage degeneration, with a significant personal and societal impact
One in four Canadians suffer from osteoarthritis, with a growing economic burden estimated, through direct and indirect costs associated with this disease, in 2010 at $27.5 Billion and increasing by 2040 to almost $1.5 trillion [1]
30% of the Canadian labor force is expected in the coming decade to experience pain related to osteoarthritis, which often leads to disability [1, 7, 8]

Summary

Introduction

Costs associated with OA management involve direct treatment strategies (clinic assessments, medications, orthotics, surgery), and significant indirect costs (loss of productivity of patient and caregivers through both physical and mental burden) [1,2,3,4,5,6]. One in four Canadians suffer from osteoarthritis, with a growing economic burden estimated, through direct and indirect costs associated with this disease, in 2010 at $27.5 Billion and increasing by 2040 to almost $1.5 trillion [1]. 30% of the Canadian labor force is expected in the coming decade to experience pain related to osteoarthritis, which often leads to disability [1, 7, 8]. With the increasing incidence rates of OA, effective short- and long-term management strategies are required to cope with this disease

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