Estimating the Budget Impact and Joint Replacement Avoidance by Implementing a Standardized Education and Exercise Therapy Program for Hip and Knee Osteoarthritis in a Publicly Insured Healthcare System.

Abstract

Listen

Translate article

Estimate the budget impact of funding a standardized education and exercise therapy program (GLA:D®) for people with hip and knee OA waiting for total joint replacement (TJR) consultation in a universal publicly insured healthcare system in Canada. We built a budget impact analysis (BIA) model to estimate the annual cost of providing GLA:D® program to people waiting for TJR consultation and then forecasted a three-year budget cycle. The base case assumes 40% attend GLA:D®, 11% avoid surgery, uniform care delivery, training costs are incurred separately, and the healthcare system has enough trained staff to meet demand. The population of people with hip and knee OA waiting for TJR consultation was estimated with government statistics, peer-reviewed evidence and routinely collected data from five orthopaedic centralized intake clinics (serving 80% of people seeking TJR). Patient-level costs were collected prospectively. International published evidence-informed estimates of TJR avoidance. One-way sensitivity analysis of key parameters evaluated model robustness. Four scenarios were analysed: public-funding for everyone (base case), low-income, rural, or uninsured persons. Funding GLA:D® would cost $4.3 million, serve 12,500 people, and save $8.5 million by avoiding 1,300 TJRs in year one. Savings grow to $8.8 and $8.7 million in year two and three. The number of TJR's performed annually produced the most uncertainty in budget impact (-$15.3, -$1.8 million). The most cautious parameter estimates still produce cost-savings. Publicly funding standardized education and exercise therapy programs for everyone waiting for TJR consultation would avoid surgeries, improve access to evidence-based treatments and save more than the program costs.