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

نویسندگان

  • Richard C Mather
  • Kevin T Hug
  • Lori A Orlando
  • Tyler Steven Watters
  • Lane Koenig
  • Ryan M Nunley
  • Michael P Bolognesi
چکیده

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.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Total Knee Arthroplasty in Severe Unstable Knee: Case-Report and Literature Review

  Multiplanar or global laxity in arthritic knee is rare , most of this patients have neuromuscular disorder (post poliomyelitis , spinal dystrophy) or history of knee trauma. Ligament insufficiency and severe bone loss is significant in this patient. The estimated prevalence for the concurrence of charcot marie-tooth (CMT) with myasthenia gravis (MG) suggests an extremely rare event. We have p...

متن کامل

Effect of a Self-Care Application on Pain and Motor Rehabilitation Following Total Knee Arthroplasty

 Background and purpose: Today, development of telemedicine technology has led to wide use of smartphone to connect patients and health care teams to improve patient care. The aim of this study was to determine the effect of a self-care application on pain and mobility rehabilitation in patients following total knee arthroplasty surgery. Materials and methods: A randomized controlled clinical ...

متن کامل

The Role of Digital Technologies as an Alternative for Face-to-Face Knee Rehabilitation: A Systematic Review

Background: Digital technologies, including mobile applications, websites, and wearable devices, like smartwatches are among the newest approaches in prevention, care, and treatment studies; they could provide public access to high-quality rehabilitation services. The current review study aimed to evaluate the effects of digital technologies for enhancing physical activity, as well as improving...

متن کامل

Brucella Arthritis Following Total Knee Arthroplasty in a Patient with Hemophilia: A Case Report

Total knee arthroplasty (TKA) is a rewarding procedure in patients with hemophilia and end stage knee hemophilicarthropathy. However, this procedure might be associated with complications such as infection. There periprostheticjoint infection in patients with hemophilia is very well known, though we are not aware of any previous report on Brucellainfection in this group of patients. Here, we re...

متن کامل

Loosening of Total Knee Arthroplasty after Brucellosis Infection: A Case Report

  In this report we describe a 78-year-old man whose total knee arthroplasty showed the symptoms of infection with brucella with radiographic signs of loosening 5 years after the index surgery. The patient was treated successfully after a 2-stage revision arthroplasty surgery along with using rifampicin and doxycycline for 8 weeks.

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:

دوره 15  شماره 

صفحات  -

تاریخ انتشار 2014