Costs of Nonoperative Procedures for Knee Osteoarthritis in the Year Prior to Primary Total Knee Arthroplasty

Abstract

Background:The convergence of national priorities to reduce health-care costs and deliver high-value care warrants the need to examine health-care utilization. The objective of this study was to describe the costs associated with nonoperative procedures in the 1-year period leading up to primary total knee arthroplasty (TKA).Methods:An observational cohort study was conducted using the IBM Watson Health MarketScan databases. Patients with late-stage knee osteoarthritis (OA) who underwent unilateral, isolated primary TKA from January 1, 2018, to December 31, 2019, were included. The main outcome was the cost of knee OA-related payments for identified nonoperative procedures in the 1-year period before surgery. Nonoperative procedures examined were (1) physical therapy (PT); (2) bracing; (3) intra-articular injections: professional fee, hyaluronic acid (IA-HA), and corticosteroids (IA-CS); (4) medication: nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and acetaminophen; and (5) knee-specific imaging.Results:The study population included 24,492 TKA patients with a mean age of 60.4 ± 8.0 years. The average total cost of nonoperative procedures per patient was $1,355 ± $2,087. The most common nonoperative treatment prescribed was IA-CS (54.3%). The nonoperative procedure with the highest cost per patient was IA-HA ($1,019 ± $913 per patient). The total cost of nonoperative procedures was higher among female compared with male patients ($1,440 ± $2,159 versus $1,254 ± $1,992 per patient; p < 0.01). The highest costs were found for patients in the Northeast ($1,740 ± $2,437 per patient). A total of 14,346 (58.6%) and 7,831 (32.0%) of the patients had >1 and ≥3 nonoperative treatments, respectively.Conclusions:There is substantial variation in the type and the cost of nonoperative treatment for patients with late-stage OA. Future studies should investigate the effectiveness of nonoperative treatments at different stages of the disease.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Continuous co-prescription of rebamipide prevents upper gastrointestinal bleeding in NSAID use for orthopaedic conditions: A nested case-control study using the LIFE Study database

“…A case-cohort study by Bruin et al [ 16 ] found that perioperative dosing of PPIs is associated with increased prosthetic joint infections. According to a multicenter, cross-sectional study conducted in 2022 in Japan, the mean age of new patients with hip osteoarthritis was 63.5 years [ 53 ], and those patients with osteoarthritis may undergo joint replacement surgery after taking NSAIDs for an extended duration [ 54 ]. However, infection and periprosthetic fractures are serious complications of joint replacement surgery [ 55 ].…”

Observational cohort investigating health outcomes and healthcare costs after metabolic and bariatric surgery: a study protocol

“…Non-operative procedure for knee OA is physical therapy, bracing, intra-articular injections (hyaluronic and corticosteroids), and medications (opioids, NSAIDS, and acetaminophen), and knee-specific imaging (see table 2 for specific codes used to identify these procedures). 38 Medications will be identified from the outpatient pharmaceutical database, with non-steroidal anti-inflammatory drugs (NSAIDS) and opioids being identified through NDCs and acetaminophen identified based on the generic name in RED BOOK. 39 40…”

Knee

“…This excellent paper from Boston (Massachusetts, USA) set out to identify what the costs of these nonoperative interventions were using the MarketScan methodology. 6 They included all nonoperative intervention types on which there were available data (physical therapy, bracing, and intra-articular injections (hyaluronic acid, and corticosteroids)), along with prescriptions of medications and obtaining knee-specific imaging. In this study of 24,492 total knee arthroplasty patients, the costs of nonoperative procedures were $1,355 (standard deviation 2,087), despite the late stage of the disease in this group.…”