A population-based nested case-control study of the costs of hip and knee replacement surgery.
BACKGROUND
Studies of total joint arthroplasty (TJA) have not evaluated the costs and outcomes in the context of expected arthritis worsening.


OBJECTIVE
Using a cost-consequence approach, to examine changes in direct health care costs and arthritis severity after TJA for hip/knee arthritis compared with contemporaneous changes in matched controls.


METHODS
Case control study nested in a population-based prospective cohort.


METHODS
In a population cohort with disabling hip/knee osteoarthritis followed from 1996 to 2003, primary TJA recipients were matched with cohort nonrecipients on age, sex, region of residence, comorbidity, and inflammatory arthritis diagnosis.


METHODS
Pre- and postoperative total and arthritis-attributable direct health care costs, arthritis severity, and general health status were compared for cases and matched controls.


RESULTS
Of 2109 participants with no prebaseline TJA, 185 cases received a single elective TJA during the follow-up period; of these, 183 cases and controls were successfully matched. Mean age was 71 years, 77.6% were female, 35.5% had > or =2 comorbidities, and 81.5% had > or =2 joints affected. At baseline, controls had less pain and disability and lower total and arthritis-attributable health care costs than cases. After surgery, although overall health care utilization was unchanged, cases experienced significant decreases in arthritis-attributable costs (mean decrease $278 including prescription drugs) and pain and disability (P < 0.0001 for all). Over the same time period, controls experienced a significant increase in total health care costs (mean increase $1978 including prescription drugs, P = 0.04) and no change or worsening of their arthritis status.


CONCLUSIONS
Compared with matched controls, arthroplasty is associated with significant reductions in pain, disability, and arthritis-attributable direct costs.
Hawker
Gillian A
GA
Department of Medicine, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada. gillian.hawker@wchospital.ca
Badley
Elizabeth M
EM
Croxford
Ruth
R
Coyte
Peter C
PC
Glazier
Richard H
RH
Guan
Jun
J
Harvey
Bart J
BJ
Williams
J I
JI
Wright
James G
JG
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D016022:Case-Control Studies; D018672:Community Health Planning; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006233:Persons with Disabilities / Q000534:rehabilitation / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D009864:Ontario / Q000453:epidemiology; D015207:Osteoarthritis, Hip / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome