Abstract
BackgroundLimiting treatment to those recommended by the American Academy of Orthopaedic Surgeon Clinical Practice Guidelines has been suggested to decrease costs by 45% in the year prior to total knee arthroplasty, but this only focuses on expenditures leading up to, but not including, the surgery and not the entire episode of care. We evaluated the treatment costs following knee osteoarthritis (OA) diagnosis and determined whether these are different for patients who use intra-articular hyaluronic acid (HA) and/or knee arthroplasty.MethodsClaims data from a large commercial database containing de-identified data of more than 100 million patients with continuous coverage from 2012 to 2016 was used to evaluate the cumulative cost of care for over 2 million de-identified members with knee OA over a 4.5-year period between 2011 and 2015. Median cumulative costs were then stratified for patients with or without HA and/or knee arthroplasty.ResultsKnee OA treatment costs for 1,567,024 patients over the 4.5-year period was $6.60 billion (mean $4210/patient) as calculated by the authors. HA and knee arthroplasty accounted for 3.0 and 61.5% of the overall costs, respectively. For patients who underwent knee arthroplasty, a spike in median costs occurred sooner for patients without HA use (around the 5- to 6-month time point) compared to patients treated with HA (around the 16- to 17-month time point).ConclusionsNon-arthroplasty therapies, as calculated by the authors, accounted for about one third of the costs in treating knee OA in our cohort. Although some have theorized that limiting the use of HA may reduce the costs of OA treatment, HA only comprised a small fraction (3%) of the overall costs. Among patients who underwent knee arthroplasty, those treated with HA experienced elevated costs from the surgery later than those without HA, which reflects their longer time to undergoing knee arthroplasty. The ability to delay or avoid knee arthroplasty altogether can have a substantial impact on the cost to the healthcare system.
Highlights
Osteoarthritis (OA) is a degenerative disease that affects more than 30 million people in the USA [1]
Knee OA is treated using a wide spectrum of therapies, including corticosteroid (CS) injections, physical therapy (PT) modalities, braces, opioids, tramadol medications, nonsteroidal anti-inflammatory drugs (NSAIDs), and hyaluronic acid (HA) injections [8]
The treatments recommended by the American Academy of Orthopaedic Surgeons (AAOS) in their Clinical Practice Guidelines (CPG) include PT, NSAIDs, and tramadol [9]
Summary
Osteoarthritis (OA) is a degenerative disease that affects more than 30 million people in the USA [1]. The treatments recommended by the American Academy of Orthopaedic Surgeons (AAOS) in their Clinical Practice Guidelines (CPG) include PT, NSAIDs, and tramadol [9]. Losina et al found that TKA accounted for up to 61% of direct OA-related medical costs [12] They estimated that expanding eligibility criteria for TKA will lead to greater use of primary and revision TKAs and a 29% increase in lifetime knee OA-related healthcare costs. Readmission following TKA [15] and the rising burden of revision TKA [4] will further fuel the healthcare costs Limiting treatment to those recommended by the American Academy of Orthopaedic Surgeon Clinical Practice Guidelines has been suggested to decrease costs by 45% in the year prior to total knee arthroplasty, but this only focuses on expenditures leading up to, but not including, the surgery and not the entire episode of care. We evaluated the treatment costs following knee osteoarthritis (OA) diagnosis and determined whether these are different for patients who use intra-articular hyaluronic acid (HA) and/or knee arthroplasty
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