Cost analysis and sociomedical aspects of the conservative and surgical treatment of hip osteoarthritis.
BACKGROUND
Hip osteoarthritis (OA) is one of the most common causes of pain, physical disability and marked impairment of patients' physical fitness and mobility. Insufficient funding for health care contributes to prolonged waiting times for total hip replacement (THR) surgery, which has been proven to be the only effective treatment for OA. Average waiting time in Poland is estimated at 2-2.5 years. Objective. To carry out a retrospective comparative analysis of the cost of THR surgery vs. conservative treatment for OA in a variety of sociomedical aspects while patients are awaiting THR.


METHODS
Two groups of patients were compared. Group I consisted of 77 patients awaiting THR and treated with physical therapy and drugs. Group II consisted of 91 patients who underwent THR. Evaluations and comparisons were based on a modified WOMAC index, the SF-8 survey and estimates of pharmacological, procedural and orthopaedic equipment expenditures.


RESULTS
Prolonged waiting times and the associated conservative treatment costs, including drugs, physical therapy, sanatorium, orthopaedic equipment, transport, sickness benefits and costs of pharmacological treatment of complications, were shown to be approximately twice higher compared to the cost of surgical treatment. Apart from financial costs, other significant aspects should also be noted, such as deterioration of the patient's life quality and psychosocial health, and prolonged anguish.


CONCLUSIONS
Pharmacological treatment, rehabilitation, physical therapy and other methods appear to be inefficient in patients with hip OA awaiting THR and their costs are twice as high. Additionally, NSAID drugs produce GI ulcers in 25% of the patients. Psychosocial problems are also common for these patients. Surgical treatment produces a radical improvement of the quality of life and ameliorates psychosocial problems. Therefore, hip OA costs can only be reduced by shorter waiting times, which can be accomplished through an increase in funding resulting in wider access to the procedure.
Dutka
Julian
J
Department of Orthopaedic Surgery and Traumatology, Stefan Zeromski Specialised Hospital, Kraków, Poland, jdorttra@interia.pl.
Dutka
Lukasz
L
Janiszewski
Mateusz
M
Hajduk
Grzegorz
G
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D003363:Cost Control; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009983:Orthopedic Equipment / Q000191:economics; D015207:Osteoarthritis, Hip / Q000191:economics* / Q000628:therapy*; D026761:Physical Therapy Specialty / Q000191:economics; D011044:Poland; D011788:Quality of Life; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000139:chemically induced; D014850:Waiting Lists
D000894:Anti-Inflammatory Agents, Non-Steroidal