In the year before total knee arthroplasty (TKA), patients incur significant costs for nonoperative treatment and other osteoarthritis (OA) procedures, raising questions about the value of these procedures, a study reports in Journal of Bone and Joint Surgery.
The study shows “significant differences in the type and cost of nonoperative procedures for patients with late-stage knee OA before TKA,” according to a report by Eric L. Smith, MD, of New England Baptist Hospital, Boston, and colleagues.
Estimated spending of $2.4 billion over 3 years for nonoperative procedures before TKA
Using nationwide commercial insurance databases, researchers analyzed the claims of nearly 24,500 patients who underwent primary TKA in 2018 and 2019. The study examined the types and costs of nonoperative procedures in the months before TKA.
Average costs for nonoperative procedures in the year before TKA were $1,355 per patient. Knee studies were the most common procedure overall, performed in approximately 96% of patients. Intra-articular steroid injections were the most common treatment procedure performed in 54%. The least common nonoperative treatment was brace fixation, which was performed in approximately 8% of patients.
Intra-articular injections of hyaluronic acid without taking into account the payment of professional administration turned out to be the most expensive procedure: performed in approximately 13% of patients and accounted for 10% of the total costs. In comparison, steroid injections were administered to more than half of patients, but accounted for just over 1% of costs. Physical therapy was used in about 27% of patients and accounted for about 17% of costs.
Most patients underwent at least two nonoperative treatments, while more than one-third underwent three or more. Costs increased with time between diagnosis and surgery and exceeded $2,000 in patients with a 12-month duration before TKA.
Women had higher total costs for nonoperative treatment, with the largest difference in physical therapy and prescribing non-steroidal anti-inflammatory drugs. Men had higher opioid costs. Procedures and costs also varied by region, with the Northeast having the highest average cost ($1,740).
TKA is a very effective and cost-effective treatment for knee OA. The researchers note that decisions about TKA can be “extremely complex,” including factors related to patients, providers, and insurers. For example, insurers may require some period of non-operative treatment before allowing TKA coverage. With the national focus on cost reduction in high-value care, the requirement for nonoperative treatment several months prior to TKA warrants evaluation.
Extrapolated to the 600,000 TKAs performed annually in the United States, the total cost of nonoperative treatment is estimated at $2.4 billion over a 3-year period and is likely to increase in the future. The authors note some limitations of their study, mainly related to the use of insurance claims data.
“For patients who ultimately undergo TKA, the cost-effectiveness of these nonoperative treatments immediately prior to TKA needs to be carefully considered as the health care system moves toward a value-based model,” Dr. Smith and coauthors conclude. They also note that some non-operative treatments – such as intra-articular injections of steroids or hyaluronic acid or braces – do not have strong evidence of effectiveness. The researchers call for further research to focus on the benefits of non-operative treatment in different stages of knee OA.
Darren Z. Nin et al., Costs of Nonoperative Procedures for Osteoarthritis of the Knee One Year Before Primary Total Knee Arthroplasty, Journal of Bone and Joint Surgery (2022). DOI: 10.2106/JBJS.21.01415
Wolters Kluwer Health
Citation: High Nonoperative Treatment Year Total Costs for Total Knee Replacement (September 21, 2022) Retrieved September 21, 2022, from https://medicalxpress.com/news/2022-09-high-nonoperative-treatment-year-total .html
This document is subject to copyright. Except in good faith for the purpose of private study or research, no part may be reproduced without written permission. The content is provided for informational purposes only.