title: Lifetime medical costs of knee osteoarthritis management in the United States: impact of extending indications for total knee arthroplasty.
abstract: OBJECTIVE
  The impact of increasing utilization of total knee arthroplasty (TKA) on lifetime costs in persons with knee osteoarthritis (OA) is understudied.
  
  
  METHODS
  We used the Osteoarthritis Policy Model to estimate total lifetime costs and TKA utilization under a range of TKA eligibility criteria among US persons with symptomatic knee OA. Current TKA utilization was estimated from the Multicenter Osteoarthritis Study and calibrated to Health Care Cost and Utilization Project data. OA treatment efficacy and toxicity were drawn from published literature. Costs in 2013 dollars were derived from Medicare reimbursement schedules and Red Book Online. Time costs were derived from published literature and the US Bureau of Labor Statistics.
  
  
  RESULTS
  Estimated average discounted (3% per year) lifetime costs for persons diagnosed with knee OA were $140,300. Direct medical costs were $129,600, with $12,400 (10%) attributable to knee OA over 28 years. OA patients spent a mean ± SD of 13 ± 10 years waiting for TKA after failing nonsurgical regimens. Under current TKA eligibility criteria, 54% of knee OA patients underwent TKA over their lifetimes. Estimated OA-related discounted lifetime direct medical costs ranged from $12,400 (54% TKA uptake) when TKA eligibility was limited to Kellgren/Lawrence grades 3 or 4 to $16,000 (70% TKA uptake) when eligibility was expanded to include symptomatic OA with a lesser degree of structural damage.
  
  
  CONCLUSIONS
  Because of low efficacy of nonsurgical regimens, knee OA treatment-attributable costs are low, representing a small portion of all costs for OA patients. Expanding TKA eligibility increases OA-related costs substantially for the population, underscoring the need for more effective nonoperative therapies.
authors.affiliation: Harvard Medical School, Brigham and Women's Hospital, and Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Weinstein
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
authors.forename: David J
authors.initials: DJ
authors.lastname: Hunter
authors.forename: Stephanie P
authors.initials: SP
authors.lastname: Chen
authors.forename: Kristina
authors.initials: K
authors.lastname: Klara
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Suter
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Sara A
authors.initials: SA
authors.lastname: Burbine
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D020370:Osteoarthritis, Knee / Q000191:economics* / Q000601:surgery*; D014481:United States