Lifetime Medical Costs of Knee Osteoarthritis Management in the United States: Impact of Extending Indications for Total Knee Arthroplasty

Abstract

Objective The impact of increasing utilization of total knee arthroplasty (TKA) on lifetime costs in persons with knee OA is under-studied. Methods We used the Osteoarthritis Policy Model to estimate total lifetime costs and TKA utilization under a range of TKA eligibility criteria among US persons with symptomatic knee OA. Current TKA utilization was estimated from the Multicenter Osteoarthritis Study and calibrated to Health Care Utilization Project (HCUP) data. OA treatment efficacy and toxicity were drawn from published literature. Costs in 2013 USD were derived from Medicare reimbursement schedules and Red Book Online®. Time costs were derived from published literature and the US Bureau of Labor Statistics. Results Estimated average discounted (3%/year) lifetime costs for persons diagnosed with knee OA were $140,300. Direct medical costs were $129,600, with $12,400 (10%) attributable to knee OA over 28 years. OA patients spent, on average, 13 (SD 10) years waiting for TKA after failing non-surgical regimens. Under current TKA eligibility criteria, 54% of knee OA patients underwent TKA over their lifetimes. Estimated OA-related discounted lifetime direct medical costs ranged from $12,400 (54% TKA uptake) when TKA eligibility was limited to K-L 3 or 4 to $16,000 (70% TKA uptake) when eligibility was expanded to include symptomatic OA with a lesser degree of structural damage. Conclusion Due to low efficacy of non-surgical regimens, knee OA treatment-attributable costs are low, representing a small portion of all costs for OA patients. Expanding TKA eligibility increases OA-related costs substantially for a population, underscoring the need for more effective non-operative therapies.

Clinical Validation of Pain Management Manipulative Therapy for Knee Osteoarthritis With the Squeeze-Hold Technique: A Case Series

“…4 For example, 9.3 million people in the United States have symptomatic knee OA, and the average discounted lifetime costs for people with a diagnosis of knee OA are estimated at $140,300. 5 Despite the high prevalence and the significant economic burden, OA of the knee remains incurable. 6,7 The main problem with OA of the knee, and the biggest factor in the disability of patients, is pain.…”

Cartilage Oligomeric Matrix Protein Levels in Synovial Fluid in Patients With Primary Knee Osteoarthritis And Healthy Controls: A Preliminary Comparative Analysis With Serum Cartilage Oligomeric Matrix Protein

“…Thus, this group have suggested that COMP may be used as a potential biomarker to diagnose OA patients, suggesting also the possibility to establish cutoff serum COMP levels to discriminate between the grades of severity of disease. 2 Our study aimed to measure and compare serum and SF COMP levels in patients with primary KOA and healthy individuals to find out whether COMP could have a potential role for diagnosis in KOA patients. Moreover, we aimed to compare SF and serum levels of this biomarker considering age, sex, severity of disease and diurnal variation.…”

“…2 In Mexico, the prevalence of OA is estimated at 14% and it has been considered as the fourth cause of morbidity in adults over 60 years of age. 3 Knee osteoarthritis involves cartilage degradation, joint space narrowing, osteophyte formation at the joint margins, and subchondral changes.…”

7th International Workshop on Osteoarthritis Imaging report: “imaging in OA – now is the time to move ahead”

“…Jeff Katz presented the socio-economic relevance of total knee replacement (TKR) 43 . Dr. Katz explained that an increasing trend in TKR utilization can be due to increasing incidence and prevalence of knee OA, expanding indications to younger and less functionally disabled patients, growing availability of orthopedic hardware, and changing patient preferences.…”