Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Arthroplasty. 2022 Oct;37(10):1967-1972.e1. doi: 10.1016/j.arth.2022.04.040. Epub 2022 May 4.
In the United States, patients with late-stage knee osteoarthritis (OA) often undergo several nonoperative treatments and related procedures prior to total knee arthroplasty. The costs of these treatments and procedures are substantial, and the variation in healthcare costs among different groups of patients may exist. The purpose of this study is to examine these costs and determine the drivers of costs in patients with the highest healthcare expenditure.
An observational cohort study was conducted using the IBM Watson Health MarketScan databases from January 1, 2017 to December 31, 2019. The primary outcome was the cost of payments for nonoperative procedures which included (i) physical therapy (PT), (ii) bracing, (iii) intra-articular injections: professional fee, hyaluronic acid (IA-HA), and corticosteroids (IA-CS), (iv) medication: nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and acetaminophen, and (v) knee-specific imaging.
Among the 24,492 patients included in the study, the total payments per patient for nonoperative care were $3,735 ± 3,049 in the highest payment quartile (Q4) and $137 ± 70 in the lowest payment quartile (Q1). Per-patient-per-month costs generally increased across quartiles for procedures. Comparing Q4 to Q1, the largest changes in prevalence were found in IA-HA (348×), bracing (10×), and PT (7×). Patients who were prescribed IA-HA and PT had a 28.3-times and 4.8-times greater likelihood, respectively, to be a higher-paying patient.
Unequal healthcare costs in the nonoperative treatment of late-stage knee OA are driven by differences in prevalent management strategies. Overall healthcare expenditure may be reduced if only guideline-concordant treatments are used.
在美国，晚期膝关节骨关节炎（OA）患者在接受全膝关节置换术之前，通常会接受多次非手术治疗和相关手术。这些治疗和手术的费用很高，不同患者群体之间的医疗保健费用可能存在差异。本研究旨在检查这些成本，并确定医疗费用最高的患者的成本驱动因素。
本研究采用 IBM Watson Health MarketScan 数据库，进行了一项观察性队列研究，时间为 2017 年 1 月 1 日至 2019 年 12 月 31 日。主要结局是为非手术治疗支付的费用，包括（i）物理治疗（PT），（ii）支具，（iii）关节内注射：专业费用，透明质酸（IA-HA）和皮质类固醇（IA-CS），（iv）药物：非甾体抗炎药（NSAIDs），阿片类药物和对乙酰氨基酚，（v）膝关节特定成像。
在这项研究中，共纳入了 24492 名患者，在支付最高的四分位数（Q4）中，每位患者的非手术治疗总支付费用为 3735 美元±3049 美元，而在支付最低的四分位数（Q1）中，每位患者的支付费用为 137 美元±70 美元。手术的各分位数中，患者的每月每人费用普遍逐月增加。与 Q1 相比，Q4 中 IA-HA（348 倍）、支具（10 倍）和 PT（7 倍）的流行率变化最大。接受 IA-HA 和 PT 治疗的患者，作为高支付患者的可能性分别增加了 28.3 倍和 4.8 倍。
晚期膝关节 OA 非手术治疗的医疗保健费用不平等，是由不同的主流治疗策略所驱动的。如果仅使用符合指南的治疗方法，可能会降低整体医疗保健费用。
