Mazzei Darren R, Whittaker Jackie L, Faris Peter, Wasylak Tracy, Marshall Deborah A
University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada.
University of Calgary, Calgary, Alberta, and Arthritis Research Canada and the University of British Columbia, Vancouver, British Columbia, Canada.
Arthritis Care Res (Hoboken). 2025 Jun;77(6):744-752. doi: 10.1002/acr.25492. Epub 2025 Feb 6.
The study objective was to estimate the budget impact of funding a standardized education and exercise therapy program, Good Life with osteoArthritis in Denmark (GLA:D) for people with hip and knee osteoarthritis (OA) waiting for total joint replacement (TJR) consultation in a universal publicly insured health care system in Canada.
We built a budget impact analysis model to estimate the annual cost (Canadian dollars) of providing the GLA:D program to people waiting for a TJR consultation and then forecasted a three-year budget cycle. The base case assumes that 40% attend GLA:D sessions, that 11% avoid surgery, uniform care delivery, that training costs are incurred separately, and that the health care system has enough trained staff to meet demand. The population of people with hip and knee OA waiting for a TJR consultation was estimated with government statistics, peer-reviewed evidence, and routinely collected data from five orthopedic centralized intake clinics (serving 80% of people seeking TJR). Patient-level costs were collected prospectively. International published evidence informed the TJR avoidance estimates. A one-way sensitivity analysis of key parameters evaluated model robustness. Four scenarios were analyzed: public funding for everyone (base case), low-income, rural, and uninsured persons.
Funding GLA:D would cost $4.3 million, serve 12,500 people, and save $8.5 million by avoiding 1,300 TJRs in year one. Savings grow to $8.8 and $8.7 million in years two and three. The number of TJRs performed annually produced the most uncertainty in budget impact (-$15.3 million, -$1.8 million). The most cautious parameter estimates still produce cost savings.
Publicly funding standardized education and exercise therapy programs for everyone waiting for a TJR consultation would avoid surgeries, improve access to evidence-based treatments, and save more than the program costs.
本研究旨在评估在加拿大全民公共保险医疗体系中，为等待全关节置换（TJR）咨询的髋膝关节骨关节炎（OA）患者提供标准化教育和运动疗法项目——丹麦骨关节炎美好生活（GLA:D）的预算影响。
我们构建了一个预算影响分析模型，以估算为等待TJR咨询的患者提供GLA:D项目的年度成本（加元），并预测三年预算周期。基础案例假设40%的患者参加GLA:D课程，11%的患者避免手术，护理服务统一，培训成本单独产生，且医疗体系有足够的训练有素的工作人员满足需求。利用政府统计数据、同行评审证据以及从五个骨科集中接诊诊所（服务80%寻求TJR的患者）定期收集的数据，估算等待TJR咨询的髋膝关节OA患者数量。前瞻性收集患者层面的成本数据。国际发表的证据为TJR避免率估算提供依据。对关键参数进行单向敏感性分析以评估模型稳健性。分析了四种情景：为所有人提供公共资金（基础案例）、低收入人群、农村人群和未参保人群。
资助GLA:D项目将花费430万加元，服务12,500人，在第一年通过避免1300例TJR节省850万加元。第二年和第三年节省金额分别增至880万加元和870万加元。每年进行的TJR数量在预算影响方面产生的不确定性最大（-1530万加元，-180万加元）。最保守的参数估计仍能产生成本节约。
为所有等待TJR咨询的患者提供标准化教育和运动疗法项目的公共资金，将避免手术，改善循证治疗的可及性，并节省超过项目成本的费用。
