Lifetime medical costs of knee osteoarthritis management in the United States: Impact of extending indications for total knee arthroplasty
Elena Losina, PhD,1,2,3 A. David Paltiel, PhD,4 Alexander M. Weinstein, BA,1 Edward Yelin, PhD,5 David J. Hunter, MBBS, PhD,6 Stephanie P. Chen, BS,1 Kristina Klara, BS,1 Lisa G. Suter, MD,4,7 Daniel H. Solomon, MD, MPH,2,8 Sara A. Burbine, BA,1 Rochelle P. Walensky, MD, MPH,2,9,10,11 and Jeffrey N. Katz, MD, MSc1,2,8Knee
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.
Link to article