A new JBJS study reviews costs associated with nonoperative management of osteoarthritis in the 1-year period leading up to total knee arthroplasty (TKA). JBJS Deputy Editor for Social Media Dr. Matt Schmitz offers this post on the investigation by Nin et al.
Cost containment in health care continues to be a hot topic in orthopaedic and medical research. Health utilization costs are being scrutinized across the board in the U.S. as we look to deliver high-quality care at a lower cost burden.
In the current issue of JBJS, Nin et al. present their results of an observational cohort study performed using the IBM Watson Health MarketScan databases. They reviewed 24,492 patients undergoing unilateral primary TKA for late-stage osteoarthritis over a 2-year period.
They assessed the cost of nonoperative treatments and procedures in the year leading up to TKA. These nonoperative modalities included: physical therapy, bracing, injections (either corticosteroids or hyaluronic acid along with their professional fees), medications, and knee-specific imaging.
The authors found:
- The average total cost of nonoperative procedures per patient was $1,355 ± $2,087. The total cost within this cohort: $33 million.
- There was substantial variation in the costs of care by region. The highest costs were found in the Northeast ($1,740 ± $2,437 per patient). Costs were lowest in the West ($1,204 ± $1,951 per patient). Costs in the Northeast were significantly higher than in the Midwest, South, and West.
- Imaging was the most common modality utilized, while the injection of hyaluronic acid was the most costly, despite not being recommended for routine use according to the most recent American Academy of Orthopaedic Surgeons Clinical Practice Guideline (AAOS CPG).
- Opioids (despite strong recommendation against their being prescribed in the AAOS CPG) were utilized for nearly 30% of the patients.
Despite the limitations of large database studies, the findings are interesting and thought-provoking. Although nonoperative modalities can absolutely be useful in patients with arthritis, one has to question the usefulness in the more immediate period preceding TKA. This could be an area to trim health-care costs.
The authors suggest that future studies should perhaps evaluate the effectiveness of nonsurgical treatments in various stages of the disease. With an estimated 600,000 TKAs performed annually in the U.S. and increasing, there is definitely potential for cost-savings in this population. Even simply following the AAOS CPG could potentially save nearly $4 million of the $33 million spent in this cohort of patients.
Matthew R. Schmitz, MD
JBJS Deputy Editor for Social Media
Related reading on OrthoBuzz: The Evidence Against Viscosupplementation for Symptomatic Knee Osteoarthritis; Does “Prehabilitation” Prior to TKA Help or Not?; What’s New in Adult Reconstructive Knee Surgery 2022