Publicly funded exercise program could reduce joint replacement surgeries, save money
Key takeaways:
- A publicly funded GLA:D program for patients awaiting joint replacement could yield net savings of more than $8 million each year.
- Such a program could help avoid 1,300 total joint replacements in its first year.
A publicly funded exercise and education program for all patients awaiting joint replacements could reduce surgeries, alleviate wait times and result in net savings, according to data published in Arthritis Care & Research.
“In Canada, $1.26 billion is spent annually performing over 100,000 TJRs and demand is expected to increase,” Darren R. Mazzei, PhD, of the University of Calgary, and colleagues wrote. “Many publicly funded healthcare systems struggle with long wait times for [total joint replacement (TJR)]. Wait times have also worsened because surgery volumes were reduced during the COVID-19 pandemic to maintain hospital bed capacity
“Ensuring everyone undergoing TJR is end stage by optimizing nonsurgical care before surgery may help alleviate long wait times, but resource implications are an important consideration for decision-makers,” they added.
To investigate some of those budgetary unknowns, Mazzei and colleagues estimated the affordability of a publicly funded exercise and education program for patients awaiting total joint replacement. Specifically, they conducted a 3-year budget impact analysis for the Ministry of Health in Alberta, Canada, to fund the Good Life with Osteoarthritis in Denmark (GLA:D) program.
“GLA:D includes two education sessions and 12 supervised neuromuscular exercise sessions delivered twice per week,” Mazzei and colleagues wrote. “Eighty-five thousand people in 10 countries have taken GLA:D, with most paying out of pocket because many health care systems and reimbursement plans do not include standardized education and exercise therapy programs.”
The budget impact analysis was conducted under guidelines from the International Society for Pharmacoeconomics and Outcomes Research. Parameters for the analysis — including the population waiting for TJR, forecasted demand, GLA:D participation rates and cost estimates — were gathered from government data sources, peer-reviewed literature and routine data from five orthopedic centralized intake clinics.
According to the researchers, publicly funding GLA:D would cost $4.3 million in the first year and yield net savings of around $8.5 million, returning about $2 for every $1 invested. In the first year, an estimated 1,374 people would avoid surgery.
In years 2 and 3, the overall budgetary impact was estimated to be a net savings of $8.8 million and $8.7 million, respectively.
“Using queueing theory, we estimate that the 90th percentile wait time for TJR would be reduced by 12.3 weeks if 11% of GLA:D participants avoided surgery,” Mazzei and colleagues wrote. “Health care systems could spend $4 million offering GLA:D to everyone waiting for TJR consultation or $14 million increasing surgical volumes to achieve the same wait time reductions.
“Our results suggest that providing GLA:D to everyone waiting for TJR consultation would avoid surgeries and save more than the program costs in a universal publicly insured health care system like Canada’s,” they added. “Funding GLA:D prior to TJR consultation would be an affordable solution to reduce wait times in publicly funded healthcare systems.”
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