University of British Columbia, Vancouver, British Columbia, Canada.
Arthritis Research Canada, Richmond, British Columbia, Canada.
PLoS One. 2021 Dec 8;16(12):e0261017. doi: 10.1371/journal.pone.0261017. eCollection 2021.
The purpose of this study was to compare three strategies for reducing population health burden of osteoarthritis (OA): improved pharmacological treatment of OA-related pain, improved access to joint replacement surgery, and prevention of OA by reducing obesity and overweight.
We applied a validated computer microsimulation model of OA in Canada. The model simulated a Canadian-representative open population aged 20 years and older. Variables in the model included demographics, body mass index, OA diagnosis, OA treatment, mortality, and health-related quality of life. Model parameters were derived from analyses of national surveys, population-based administrative data, a hospital-based cohort study, and the literature. We compared 8 what-if intervention scenarios in terms of disability-adjusted life years (DALYs) relative to base-case, over a wide range of time horizons.
Reductions in DALYs depended on the type of intervention, magnitude of the intervention, and the time horizon. Medical interventions (a targeted increase in the use of painkillers) tended to produce effects quickly and were, therefore, most effective over a short time horizon (a decade). Surgical interventions (increased access to joint replacement) were most effective over a medium time horizon (two decades or longer). Preventive interventions required a substantial change in BMI to generate a significant impact, but produced more reduction in DALYs than treatment strategies over a very long time horizon (several decades).
In this population-based modeling study we assessed the potential impact of three different burden reduction strategies in OA. Data generated by our model may help inform the implementation of strategies to reduce the burden of OA in Canada and elsewhere.
本研究旨在比较三种减轻骨关节炎（OA）人群健康负担的策略：改善与 OA 相关疼痛的药物治疗、改善关节置换手术的可及性以及通过减少肥胖和超重来预防 OA。
我们应用了加拿大验证过的 OA 计算机微观模拟模型。该模型模拟了一个具有加拿大代表性的 20 岁及以上的开放人群。模型中的变量包括人口统计学、体重指数、OA 诊断、OA 治疗、死亡率和与健康相关的生活质量。模型参数来自全国性调查、基于人群的行政数据、基于医院的队列研究和文献分析。我们根据残疾调整生命年（DALY），在广泛的时间范围内，比较了 8 种假设干预情景与基础情况的相对情况。
DALY 的减少取决于干预的类型、干预的幅度和时间范围。医疗干预（有针对性地增加止痛药的使用）往往会迅速产生效果，因此在短时间范围内（十年）效果最为显著。手术干预（增加关节置换的可及性）在中时间范围内（二十年或更长时间）效果最为显著。预防干预需要 BMI 发生实质性变化才能产生显著影响，但在很长的时间范围内（几十年）比治疗策略产生更多的 DALY 减少。
在这项基于人群的建模研究中，我们评估了三种不同的 OA 负担减轻策略的潜在影响。我们的模型生成的数据可能有助于为在加拿大和其他地方实施减轻 OA 负担的策略提供信息。
