Associations of Healthcare Utilization and Costs with Increasing Pain and Treatment Intensity Levels in Osteoarthritis Patients: An 18-Year Retrospective Study

Abstract

Introduction Osteoarthritis (OA) is a complex disease, and prior studies have documented the health and economic burdens of patients with OA compared to those without OA. Our goal was to use two strategies to further stratify OA patients based on both pain and treatment intensity to examine healthcare utilization and costs using electronic records from 2001 to 2018 at a large integrated health system. Methods Adult patients with ≥1 pain numerical rating scale (NRS) and diagnosis of OA were included. Pain episodes of ≥90 days were defined as mild (0–3), moderate (4–6), or severe (7–10) based on initial NRS. Patients were initially classified as mild and moved to moderate-severe OA if any of eight treatment-based criteria were met. Outpatient visits (OP), emergency department visits (ED), inpatient days, and healthcare costs (both all-cause and OA-specific) were compared among pain levels and OA severity levels as frequencies and per-member-per-year rates, using generalized linear regression models adjusting for age, sex, and body mass index, with contrasts of p < 0.05 considered significant. Results We identified 127,656 patients, 92,576 with pain scores. Moderate and severe pain were associated with significantly higher rates of OA-related utilization and costs, and all-cause ED visits and pharmacy costs. Moderate-severe OA patients had significantly higher OA-related utilization and costs, and all-cause OP, ED and pharmacy costs. Conclusions Pain and treatment intensity were both strongly associated with OA-related utilization but not consistently with all-cause utilization. Our results provide promising evidence of better criteria and approaches for predicting disease burden and costs in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00448-7.

Use and Cost of Healthcare Services Among Patients with Moderate-to-Severe Osteoarthritis of Hip/Knee with Inadequate Analgesia: Findings from two United States Health Systems

“…Relatively low rates of ED visits were observed in both cohorts; this is possibly due to the nature of the disease which is characterized by pain and limitations in activities. (35,36) During the six-month baseline period, recorded use of NSAIDs and opioids was low. The relatively low prevalence of prescription NSAIDs use may be explained, at least partially, by the relative severity of OA in the sample; unlike other studies (37,38), the index date of the case patients (i.e., the date when patients were considered to have moderate-to-severe disease with inadequate response to painrelated medications) and randomly assigned pseudo-index date for the comparator patients in this study are relatively later in treatment pathways, which means NSAIDs may no longer offer adequate symptom relief for some patients and consequently may not be prescribed and captured in our data.…”