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Patients with late-stage knee OA incur high costs for nonsurgical treatments prior to total knee arthroplasty
In the year before total knee arthroplasty (TKA), patients incur significant costs for nonsurgical treatments and other procedures for osteoarthritis (OA) — raising questions about the value of these procedures, reports a study in the Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in collaboration with Wolters Kluwer. The study shows “significant differences in the type and cost of nonsurgical interventions in patients with late-stage knee OA before TKA,” according to the report by Eric L. Smith, MD, of New England Baptist Hospital, Boston, and colleagues. Estimated cost of $2.4 billion over 3 years for non-surgical interventions before TKA Under...
Patients with late-stage knee OA incur high costs for nonsurgical treatments prior to total knee arthroplasty
In the year before total knee arthroplasty (TKA), patients incur significant costs for nonsurgical treatments and other procedures for osteoarthritis (OA) — raising questions about the value of these procedures, reports a study in the Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in collaboration with Wolters Kluwer.
The study shows “significant differences in the type and cost of nonsurgical interventions in patients with late-stage knee OA before TKA,” according to the report by Eric L. Smith, MD, of New England Baptist Hospital, Boston, and colleagues.
Estimated cost of $2.4 billion over 3 years for nonsurgical interventions prior to TKA
Using nationwide commercial insurance databases, researchers analyzed claims from nearly 24,500 patients who underwent primary TKA in 2018 and 2019. The study examined the types and costs of nonsurgical procedures in the months before TKA.
The average cost of nonsurgical procedures in the year before TKA was $1,355 per patient. Knee imaging studies were the most common procedure overall, performed in approximately 96% of patients. Intra-articular steroid injections were the most common treatment procedure, performed in 54%. Orthoses were the least common nonsurgical treatment and were performed in approximately 8% of patients.
Intra-articular injection of hyaluronic acid, excluding professional administration fees, was the most expensive procedure: it was performed in approximately 13% of patients and accounted for 10% of the total cost. In comparison, steroid injections were performed in more than half of patients but accounted for just over 1% of the cost. Physiotherapy was used in approximately 27% of patients and accounted for approximately 17% of the cost.
Most patients underwent at least two nonsurgical treatments, while more than a third underwent three or more treatments. Costs increased with time between diagnosis and surgery, exceeding $2,000 in patients 12 months prior to TKA.
Women had higher total costs for nonoperative treatment, with the largest differences occurring in physical therapy and nonsteroidal anti-inflammatory drug prescriptions. Men had higher opioid costs. Procedures and costs also varied by region, with the Northeast region having the highest average cost ($1,740).
TKA is a highly effective and cost-effective treatment for knee OA. The researchers note that decisions about TKA can be “extremely complicated” and involve factors related to patients, providers and insurers. For example, insurers may require a certain period of non-surgical treatment before authorizing coverage for TKA. With the national focus on reducing costs while providing quality care, the need for nonoperative treatment in the months prior to TKA warrants evaluation.
Extrapolating from the 600,000 TKAs performed each year in the United States, the total cost of nonoperative treatment is estimated at $2.4 billion over 3 years and is likely to increase in the future. The authors note some limitations to their study, primarily related to the use of insurance claims data.
“For patients who ultimately undergo TKA, the cost-effectiveness of these non-surgical treatments immediately prior to TKA must be carefully considered as the healthcare system moves to a value-based model,” conclude Drs. Smith and co-authors. They also note that some nonsurgical treatments – for example, intra-articular steroid or hyaluronic acid injections or splints – do not have strong evidence of effectiveness. The researchers call for further studies that focus on the benefits of non-surgical treatments in different stages of knee osteoarthritis.
Source:
Reference:
Nin, DZ, et al. (2022) Costs of nonsurgical procedures for knee osteoarthritis in the year before primary total knee arthroplasty. The Journal of Bone and Joint Surgery. doi.org/10.2106/JBJS.21.01415.
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