Wait times, resource use and health-related quality of life across the continuum of care for patients referred for total knee replacement surgery

Abstract

Background: The escalating socioeconomic burden of knee osteoarthritis (OA) underscores the need for innovative strategies to reduce wait times for total knee arthroplasty (TKA). The purpose of this study was to evaluate resource use, costs and health-related quality of life (HRQoL) across the continuum of care for patients with knee OA. Methods: This was a prospective study of 383 patients recruited from a high-volume teaching hospital at different stages of care (referral, consultation and presurgery). Outcomes included health care resource use; costs captured from the health care payer, private sector and societal perspectives; HRQoL measured using the Western Ontario and McMaster Universities Osteoarthritis Index, the 12-Item Short Form Health Survey, and EuroQoL 5-Dimension 5-Level tool; wait times; and the proportion of referrals deemed suitable candidates for surgery. Results: The most commonly used conservative treatments were pharmacotherapy, exercise and lifestyle modification. Forty percent of patients referred for TKA were deemed not to be suitable candidates for surgery. The greatest proportion of costs was borne by the patient or private insurer; a small proportion was borne by the public payer. Across all stages of care, more than 60% of the total costs was attributed to productivity losses. HRQoL remained relatively stable throughout the waiting period (mean wait time from referral to TKA 13.2 mo) but improved postoperatively. Conclusion: The suboptimal primary care management of knee OA calls for the development of innovative models of care. This study may provide valuable guidance on the design and implementation of a new online educational platform to improve referral efficiency and expedite wait times for TKA.

Variation in the utilisation of physiotherapy in patients with advanced knee osteoarthritis prior to total knee arthroplasty a systematic review

“…Eighteen studies were identified as eligible for this systematic review (Aoyagi et al., 2021; Bedard et al., 2017; Cronström et al., 2020; Dhawan et al., 2014; Grace et al., 2022; Hofstede et al., 2015; Ingelsrud et al., 2020; Jacobs et al., 2022; King et al., 2020; Lamb et al., 2008; Lange et al., 2018; Lebedeva et al., 2021; McHugh et al., 2007, 2011; Power et al., 2005; van Zaanen et al., 2020; Ward, 2021; Warwick et al., 2020) (see flowchart in Figure 1). After screening 1306 titles/abstracts and 36 full‐text articles, 12 studies were identified through the literature search (Bedard et al., 2017; Dhawan et al., 2014; Grace et al., 2022; Ingelsrud et al., 2020; Jacobs et al., 2022; King et al., 2020; Lamb et al., 2008; Lange et al., 2018; Lebedeva et al., 2021; McHugh et al., 2007; van Zaanen et al., 2020; Ward, 2021), whereas six additional studies were found through reference checking of the included studies (Aoyagi et al., 2021; Cronström et al., 2020; Hofstede et al., 2015; McHugh et al., 2011; Power et al., 2005; Warwick et al., 2020).…”

“…Fourteen of the included studies used a cross‐sectional study design (Aoyagi et al., 2021; Bedard et al., 2017; Cronström et al., 2020; Dhawan et al., 2014; Grace et al., 2022; Hofstede et al., 2015; Ingelsrud et al., 2020; Jacobs et al., 2022; King et al., 2020; Lange et al., 2018; Power et al., 2005; van Zaanen et al., 2020; Ward, 2021; Warwick et al., 2020), three studies used a longitudinal study design (prospective) (Lebedeva et al., 2021; McHugh et al., 2007, 2011), and one study used a non‐randomised interventional design without a control group (Lamb et al., 2008). Response rate was considered ‘not applicable’ for six studies, because data were extracted from data‐bases and medical records (Aoyagi et al., 2021; Bedard et al., 2017; Dhawan et al., 2014; Lange et al., 2018; Ward, 2021; Warwick et al., 2020).…”

“…Response rate was considered ‘not applicable’ for six studies, because data were extracted from data‐bases and medical records (Aoyagi et al., 2021; Bedard et al., 2017; Dhawan et al., 2014; Lange et al., 2018; Ward, 2021; Warwick et al., 2020). However, 10 studies reported of an adequate response rate (Cronström et al., 2020; Grace et al., 2022; Hofstede et al., 2015; Ingelsrud et al., 2020; Jacobs et al., 2022; King et al., 2020; Lamb et al., 2008; McHugh et al., 2007, 2011; Power et al., 2005), whereas two were ‘unclear’ (Lebedeva et al., 2021; van Zaanen et al., 2020). Study characteristics and defining characteristics of the included studies are illustrated in Table 1.…”

“…Included studies examined practice patterns in the United States (Aoyagi et al., 2021; Bedard et al., 2017; Dhawan et al., 2014; Grace et al., 2022; Ward, 2021; Warwick et al., 2020), the United Kingdom (Lamb et al., 2008; McHugh et al., 2007, 2011), Canada (Lebedeva et al., 2021; McHugh et al., 2007; Power et al., 2005), the Netherlands (Hofstede et al., 2015; van Zaanen et al., 2020), Germany (Jacobs et al., 2022; Lange et al., 2018), Denmark (Ingelsrud et al., 2020), and Sweden (Cronström et al., 2020). Sample sizes of the included studies ranged from 40 to 327,499 patients.…”

Estimating the health impact of delayed elective care during the COVID -19 pandemic in the Netherlands

“…Any other effects of waiting time on health status and QALY gains were not included in our analysis, as conflicting evidence had been found in the literature. Various studies did not find a clear effect of waiting time on postoperative health status ( Ostendorf et al, 2004 ; Tuominen et al, 2010), while others found that waiting time was associated with a poorer health after surgery (worse in – worse out) ( Clement et al, 2021 ; Lebedeva et al, 2021 ; Röder et al, 2007 ; Vergara et al, 2011 ). T is likely that the prolonged waiting times during the pandemic have led to additional health losses, for example due to disease progression or premature death.…”