Impact of Knee Osteoarthritis on Health Care Resource Utilization in a US Population-Based National Sample

Abstract

Objective We sought to estimate the impact of knee osteoarthritis (OA) on health care utilization. Research Design Using the 2003 Medicare Current Beneficiary Survey, a population-based survey of Medicare beneficiaries linked to Medicare claims, we selected a national cohort of community-dwelling persons aged 65 and older with knee OA and a sex- and age-matched comparison cohort without any form of OA. We distinguished following 4 components of health care utilization: physician (MD) office visits, non-MD office visits, inpatient hospital stays, and emergency department visits. We built multiple regression models to determine whether knee OA affects utilization, controlling for comorbidity count, obesity, functional limitation, education, race, and working status. Results A total of 545 Medicare Current Beneficiary Survey participants with knee OA were matched with 1090 OA-free individuals. Mean age in both cohorts was 76 years; approximately 70% were female. Knee OA and OA-free subjects differed significantly in obesity (Knee OA: 37%, OA-free: 20%), % with ≥2 comorbidities (Knee OA: 69%, OA-free: 43%), and functional limitation (Knee OA: 42%, OA-free: 26%). In multivariable regression models, the knee OA cohort had on average 6.0 more annual MD visits (95% confidence interval [CI]: 4.7, 7.4) and 3.8 more non-MD visits (95% CI: 2.8, 4.7) than the OA-free cohort. The knee OA cohort also had 28% more hospital stays (odds ratio [OR] = 1.3, 95% CI: 1.0, 1.6), a difference attributable to total joint replacements. Conclusions This first national, population-based study of health care utilization in persons with knee OA documents considerable excess utilization attributable to knee OA, independent of comorbidity, and other patient characteristics.

Trajectory of cartilage loss within 4 years of knee replacement – a nested case–control study from the Osteoarthritis Initiative

“…KOA is associated with substantial functional limitations and disability 3,4 , causes significant morbidity, mortality, and reduction in the quality of life, 5 , and substantial health care utilization 6 . In absence of effective disease modifying therapies, a large portion of the costs involved in managing KOA is driven by knee replacements (KR), and KR therefore represents a clinically important endpoint 7 .…”

Greater Lateral Femorotibial Cartilage Loss in Osteoarthritis Initiative Participants With Incident Total Knee Arthroplasty: A Prospective Cohort Study

“…Knee osteoarthritis (OA) is associated with increased health care utilization, a large part of the costs being related to knee replacement (KR) surgery (1). Currently, more than 4% of the U.S. adults aged ≥50 years live with a KR, and the lifetime risk of primary KR at age 25 is 7.0/9.5% in men/women.…”

Quantitative MRI measures of cartilage predict knee replacement: a case–control study from the Osteoarthritis Initiative

“…Knee osteoarthritis affects over 10% of the population,1 causes annual expenditures of US$185.5 billion in the USA,2 causes functional limitations to a similar extent as cardiovascular disease,3 reduces the quality of life4 and substantially increases healthcare utilisation 5. A major contributor to the costs is that of knee joint replacements (KR), of which 615 000 were performed in the USA in 2008 (http://www.hcupus.ahrq.gov/db/nation/nis/NIS_Introduction_2008.jsp).…”