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Some OA-related costs the year before TKR were for non-recommended treatment
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SAN DIEGO — In the year before total knee replacement, almost one-third of treatment costs for osteoarthritis symptoms went toward plans not recommended by the American Academy of Orthopaedic Surgeons, according research presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
“Much of the cost associated with outpatient management in knee osteoarthritis (OA) in the 1 year prior to total knee replacement (TKR) is not supported by the [American Academy of Orthopaedic Surgeons (AAOS)] recommendations,” study author Christopher A. Anthony, MD, an orthopedic surgeon at University of Iowa Hospitals & Clinics, said.
If these non-recommended treatments were no longer used, according to the release, costs could decrease by an estimated 30%.
Using the Humana Inc. dataset of Medicare and private claims, Nicholas A. Bedard, MD, and colleagues reviewed information for more than 86,073 patients with knee OA treated with primary TKR from 2007 to 2015. According to the abstract, the investigators included only patients who enrolled with the insurance provider for at least 1 year before TKR. For the year prior to TKA, researchers calculated reimbursement costs of hyaluronic acid (HA) and corticosteroid (CS) injections, physical therapy (PT), braces, wedge insoles, opioids, NSAIDs and tramadol. However, only short-term use of tramadol for severe pain, physical therapy and NSAIDs are recommended in the AAOS clinical practice guideline (CPG).
Researchers found the total cost linked with knee OA was $78,392,953 and the outpatient cost associated knee OA diagnosis was $43,582,648. Of the patients, 65.8% underwent at least one of the assessed treatments in the year before TKR. The costliest interventions were HA injections, CS injections and PT. In total, according to the abstract, the treatments made up 57.6% of the total non-inpatient cost of knee OA in the year before TKR. The three treatments recommended by the AAOS in the CPG (PT, NSAIDS, tramadol) represented 11.1% of non-inpatient knee OA cost; whereas, 46.5% of non-inpatient cost linked with knee OA in the year studied were for treatments not recommend by the CPG. In addition, 29.3% of costs were from treatments that had strong or moderate recommendations against their use in the CPG.
“We hope that research such as this highlights the high prevalence of low-value interventions in the management of knee osteoarthritis and helps to motivate a transition to higher value care,” Bedard said in the press release. – by Will Offit
- Reference:
- Anthony CA, et al. Paper #187. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting, March 14-18, 2017; San Diego.
- For more information:
- Christopher A. Anthony, MD, and Nicholas A. Bedard, MD, can be reached at 200 Hawkins Dr., Department of Orthopaedics and Rehabilitation, Iowa City, IA 52242; email: chris-anthony@uiowa.edu.
Disclosures: Anthony and Bedard report no relevant financial disclosures.