Economic evaluation of access to musculoskeletal care: the case of waiting for total knee arthroplasty.

Mather, Richard C

Hug, Kevin T

Orlando, Lori A

Watters, Tyler Steven

Koenig, Lane

Nunley, Ryan M

Bolognesi, Michael P

England

2017-10-23T14:54:12Z

2017-10-23T14:54:12Z

2014-01-18

BACKGROUND: The projected demand for total knee arthroplasty is staggering. At its root, the solution involves increasing supply or decreasing demand. Other developed nations have used rationing and wait times to distribute this service. However, economic impact and cost-effectiveness of waiting for TKA is unknown. METHODS: A Markov decision model was constructed for a cost-utility analysis of three treatment strategies for end-stage knee osteoarthritis: 1) TKA without delay, 2) a waiting period with no non-operative treatment and 3) a non-operative treatment bridge during that waiting period in a cohort of 60 year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective with national average Medicare reimbursement. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, effectiveness, and quality-adjusted life years; and net health benefits. RESULTS: In the base case, a 2-year wait-time both with and without a non-operative treatment bridge resulted in a lower number of average QALYs gained (11.57 (no bridge) and 11.95 (bridge) vs. 12.14 (no delay). The average cost was $1,660 higher for TKA without delay than wait-time with no bridge, but $1,810 less than wait-time with non-operative bridge. The incremental cost-effectiveness ratio comparing wait-time with no bridge to TKA without delay was $2,901/QALY. When comparing TKA without delay to waiting with non-operative bridge, TKA without delay produced greater utility at a lower cost to society. CONCLUSIONS: TKA without delay is the preferred cost-effective treatment strategy when compared to a waiting for TKA without non-operative bridge. TKA without delay is cost saving when a non-operative bridge is used during the waiting period. As it is unlikely that patients waiting for TKA would not receive non-operative treatment, TKA without delay may be an overall cost-saving health care delivery strategy. Policies aimed at increasing the supply of TKA should be considered as savings exist that could indirectly fund those strategies.

https://www.ncbi.nlm.nih.gov/pubmed/24438051

1471-2474-15-22

1471-2474

https://hdl.handle.net/10161/15648

eng

Springer Science and Business Media LLC

BMC Musculoskelet Disord

10.1186/1471-2474-15-22

Arthroplasty, Replacement, Knee

Cost Savings

Cost-Benefit Analysis

Decision Support Techniques

Health Care Costs

Health Care Rationing

Health Services Accessibility

Health Services Needs and Demand

Health Services Research

Humans

Insurance, Health, Reimbursement

Markov Chains

Medicare

Middle Aged

Models, Economic

Osteoarthritis, Knee

Patient Selection

Quality-Adjusted Life Years

Time Factors

Treatment Outcome

United States

Waiting Lists

Economic evaluation of access to musculoskeletal care: the case of waiting for total knee arthroplasty.

Journal article

Orlando, Lori A|0000-0003-2534-7855

Bolognesi, Michael P|0000-0003-1414-6863

https://www.ncbi.nlm.nih.gov/pubmed/24438051

22

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, General Internal Medicine

Orthopaedics

School of Medicine

Published online

15