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The Global Economic Cost of Osteoarthritis: How the UK Compares

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  • Royal London Hospital, Barts Health NHS Trust, London

Abstract and Figures

Aims. To examine all relevant literature on the economic costs of osteoarthritis in the UK, and to compare such costs globally. Methods. A search of MEDLINE was performed. The search was expanded beyond peer-reviewed journals into publications by the department of health, national orthopaedic associations, national authorities and registries, and arthritis charities. Results. No UK studies were identified in the literature search. 3 European, 6 North American, and 2 Asian studies were reviewed. Significant variation in direct and indirect costs were seen in these studies. Costs for topical and oral NSAIDs were estimated to be £19.2 million and £25.65 million, respectively. Cost of hip and knee replacements was estimated to exceed £850 million, arthroscopic surgery for osteoarthritis was estimated to be £1.34 million. Indirect costs from OA caused a loss of economic production over £3.2 billion, £43 million was spent on community services and £215 million on social services for osteoarthritis. Conclusions. While estimates of economic costs can be made using information from non-published data, there remains a lack of original research looking at the direct or indirect costs of osteoarthritis in the UK. Differing methodology in calculating costs from overseas studies makes direct comparison with the UK difficult.
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Hindawi Publishing Corporation
Arthritis
Volume 2012, Article ID 698709, 6pages
doi:10.1155/2012/698709
Review Article
The Global Economic Cost of Osteoarthritis:
How the UK Compares
A.Chen,C.Gupte,K.Akhtar,P.Smith,andJ.Cobb
MSKLab,ImperialCollege,LondonW68RF,UK
Correspondence should be addressed to A. Chen, alvinm.chen@gmail.com
Received 30 May 2012; Accepted 30 August 2012
Academic Editor: Charles J. Malemud
Copyright © 2012 A. Chen et al. This is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aims. To examine all relevant literature on the economic costs of osteoarthritis in the UK, and to compare such costs globally.
Methods. A search of MEDLINE was performed. The search was expanded beyond peer-reviewed journals into publications by
the department of health, national orthopaedic associations, national authorities and registries, and arthritis charities. Results.No
UK studies were identified in the literature search. 3 European, 6 North American, and 2 Asian studies were reviewed. Significant
variation in direct and indirect costs were seen in these studies. Costs for topical and oral NSAIDs were estimated to be £19.2
million and £25.65 million, respectively. Cost of hip and knee replacements was estimated to exceed £850 million, arthroscopic
surgery for osteoarthritis was estimated to be £1.34 million. Indirect costs from OA caused a loss of economic production over
£3.2 billion, £43 million was spent on community services and £215 million on social services for osteoarthritis. Conclusions. While
estimates of economic costs can be made using information from non-published data, there remains a lack of original research
looking at the direct or indirect costs of osteoarthritis in the UK. Diering methodology in calculating costs from overseas studies
makes direct comparison with the UK dicult.
1. Introduction
Musculoskeletal diseases remain one of the most common
causes for severe long-term pain and disability. The increas-
ing significance of musculoskeletal disorders has prompted
the United Nations, the World Health Organization, and 37
countries to spearhead a campaign to recognise and address
the burden of musculoskeletal disorders such as arthritis,
proclaiming it to be the Bone and Joint Decade (2000–2010)
[1], and to advance understanding and treatment of mus-
culoskeletal disorders through prevention, education, and
research.
Within the envelope of musculoskeletal disorders, Oste-
oarthritis represents a complex musculoskeletal disorder
with multiple genetic, constitutional, and biomechanical risk
factors. It represents the most common form of joint disease
and disability in older people and ranks amongst the top 5
causes of disability [2].
The economic costs of osteoarthritis can be broken down
into direct costs and indirect costs. Direct costs represent the
pharmacological/nonpharmacological treatments, including
surgery, as well as use of hospital resources and management
of complications arising from the treatment of osteoarthritis.
Indirect costs represent loss of time from work, decreased
productivity because of pain, care-giver time, premature
mortality, and disability compensation/benefits. These costs
are summarised in Tabl e 1,below.
A third category sometimes considered is that of intan-
gible costs. These are defined as the pain and suering
experienced by the patient as a result of the disease; the
reduction in the patient’s quality of life. They remain an area
of controversy, with only a few studies making the attempt to
estimate them [3].
2. Aims
The aim of this paper is to examine all relevant literature on
the economic costs of Osteoarthritis in the UK, and to see
what comparisons can be made regarding such costs in the
UK and other countries in North America, Europe, and Asia.
2Arthritis
Tab le 1
Direct costs Indirect costs Intangible costs
Costs of surgery Loss of productivity Pain and suering
Hospital resources Absenteeism Decreased quality of life
Caregiver time Premature mortality Potential depression/anxiety
Pharmacological and nonpharmacological treatment Disability payments/benefits
Costs of side eects from treatments
Research
3. Methods
A comprehensive review of the literature was performed
using a computerised bibliographical search of MEDLINE
databases from 1946 to 31st Dec 2011. English language
articles were reviewed that contained the words “economic
cost,” “direct cost,” or “indirect cost” in combination with
“osteoarthritis” in either their title or abstract.
To expand the review beyond only published studies,
an internet search was made for publications from the UK
Department of Health, the National Institute for Clinical
Excellence, the UK National Joint Registry, Hospital Episode
Statistics, and charities Arthritis Research (UK) and Arthritis
Care, and all publications were reviewed for information
on costs for osteoarthritis. Further internet searches were
made for publications from the British Orthopaedic Asso-
ciation, the Royal College of Surgeons, the Royal College of
Physicians, and the Royal College of General Practitioners.
Publications from American Association of Orthopaedic
Surgeons and other regional orthopaedic associations in
Europe and Asia were also reviewed.
4. Results
4.1. What Do We Know about OA Costs in North America?
Studies on prevalence of osteoarthritis in the United States
have shown that osteoarthritis aects 13.9% of adults aged
25 and older, and 33.6% of those over the age of 65, with an
approximate 27 million Americans of all ages suering from
disease [4].
Much of the data available on osteoarthritis in the
United States is derived from studies conducted in the
1960s and 1970s. The Framingham study [5]represented
one of the early studies to associate increasing age with
worsening knee arthritis. This study, which began in 1948,
was initially designed to look at cardiovascular risk factors in
a representative sample of people in the adult population of
Framingham, MA. The study’s patients were examined every
2 years since inception. This same cohort of patients was used
by Felson et al. to look at the prevalence of knee osteoarthritis
approximately 36 years after the start of the study. The age
of the patients in the study ranged from 63 to 94, and a
total of 1805 patients were studied. The study confirmed
that radiographic evidence of OA increased with age, with
a higher prevalence of OA changes in women, as well as a
significantly higher proportion of women with symptomatic
OA.
Lethbridge-c¸ejku et al. [6] examined discharge data
from the National Hospital Discharge Survey and concluded
that Osteoarthritis accounts for 55% of all arthritis related
hospital admissions, with 409 000 such admissions in 1997.
The annual cost of knee and hip replacements in 1997 was
estimated at $7.9 billion (£4.7 billion) [6]. Less than 10 years
later in 2004, the number of hospital admissions had risen to
632 000 and the annual total cost of joint replacements rose
to $22.6 billion (£13.8 billion) [7].
Buckwalter et al. [8] used data drawn from national
data sets collected by the U.S. Bureau of Labor Statistics,
the U.S. National Center for Health Statistics, as well as
existing cost estimates for arthritis in the literature, used
proportional attributable risk models and the human capital
method to break down costs into direct and indirect costs.
From this study, an estimated $3.4–$13.2 billion (£2 billion–
£8 billion) is spent annually on job-related OA costs in the
USA. Meanwhile, Kotlarz et al., in 2010, using evidence from
the national health survey data from 1996–2005, looked at
absenteeism as a result of osteoarthritis. This study, estimated
the indirect cost of the absenteeism to be approximately
US$10.3 billion [9]. The study also confirmed that the costs
for women were larger (US$ 5.5 billion compared to US$4.8
billion), and that absenteeism was less in subjects with lower
education and those in minority groups.
A survey done by Gupta et al, in ON, Canada in 2005,
estimated that the indirect costs incurred by a patient aged
over 55 with hip or knee arthritis may be much higher than
previously estimated when compared to direct costs ($12 990
or £8183 annually for the former, and $2300 or £1449 for the
latter) [10]. Indirect costs were incurred mostly for time lost
from employment and for unpaid informal caregivers, with
caregiver time accounting for 40% of indirect costs. It should
be noted that the authors in this study based the costs on the
monthly wage for a professional homemaker or housekeeper
as caregiver occupation was unknown. This averaged at US$
1278 (£824) per month, which may explain the relatively
higher costs reported.
March and Bachmeier (1997) looked at the global cost of
osteoarthritis and found the cost of osteoarthritis in the USA,
Canada, UK, France, and Australia to account for between 1–
2.5% of the gross national product (GNP) for those countries
[11].
4.2. How Do Recent Studies in Europe Compare? Loza et al.,
in their Spanish study, assessed the burden of knee and
hip osteoarthritis by examining 1071 patients across all the
Arthritis 3
provinces of Spain [12]. The average annual cost for OA
per patient was estimated at C1502 (£1260), with direct
costs representing 86% (£1084) of the total cost. Indirect
costs were much lower (14% or £176) and mainly involved
domestic help.
In contrast to this, the COART study [13]inFrance
attempted to estimate the overall financial cost of osteoar-
thritis to the country. The study concluded that osteoarthritis
remained a major public burden, with direct costs in 2002
exceeding 1.6 billion Euros, about 1.7% of the expenses
of the French Health system. Over 13 million visits were
made to physicians for osteoarthritis. Medication costs were
570 million euros and inpatient treatment amounted to 820
million Euros. During the period of the study, 80 000 total
hip replacements and 38 000 total knee replacements were
performed per year, at a cost of C5600 per THR and C4500
per TKR. The study compared the costs to a previous study
by Levy et al. [14] in 1993 and found that the prevalence of
the disease had risen by 54%, and the direct medical costs by
156%.
In Italy, Leardini et al. examined the economics of
osteoarthritis of the knee in 2004. They used a bottom-
up method, utilising data collected from each patient,
and reviewed patients across 29 medical institutes. They
concluded that the direct costs came to C934 (£785) and
indirect costs C1236 (£1039) per patient per year [15].
4.3. Is the Situation DierentinAsia? There have been fewer
studies with regard to economic costs of osteoarthritis in
India, China or Southeast Asia compared with countries in
the western hemisphere.
In contrast to the Western literature, Woo et al., in
their Hong Kong [16] study estimated that the cost of
osteoarthritis accounted for 0.28% of the GNP of Hong
Kong, between HK $3.2–$3.9 billion (£253 million–£308
million). The direct costs ranged from HK $4860–$11180
(£384–£883) and indirect costs HK$3300–$6640 (£261–
£525) per person annually.
Xie et al. assessed indirect costs in Singapore for OA
and noted that there were estimated at between US$1000–
1200 (£610–£730), around 2.8% and 3.3% of the annual
household income [3]. The authors here acknowledged that
these costs likely represented the lower end of the scale,
as costs such as loss of productivity of caregivers were
not estimated. The study was also one of the few that
attempted to address and estimate intangible costs using the
willingness to pay (WTP) method. In economics, this model
represents the maximum amount a person would be willing
to pay, sacrifice, or exchange in order to avoid something
undesired, in this case, the pain and suering associated
with osteoarthritis. The authors here estimated the intangible
costs at US$ 1200 (£775) per year.
4.4. What Do We Know about the Economic Cost of
OA in the UK?
4.4.1. The Prevalence of OA. The Arthritis Research Council
(UK) estimated in 2002 that at least 4.4 million patients
in the UK have X-ray evidence of moderate-to-severe
osteoarthritis in their hands, while 550 000 have similar
evidence of osteoarthritis in their knees, and 210 000 have
evidence of this in their hips [17].
Pye et al., in 2004, showed that almost 8.5 million people
in the UK have X-ray evidence of osteoarthritis in their
spine, with back pain being the most frequent symptom [18].
While predominantly a disease of the elderly, an estimated
6% of adults aged 30 and above have both knee pain and
radiographic changes of osteoarthritis [18].
The Royal College of General Practitioners estimated in
2006 that in the UK over 1 million adults consult their GP
each year with symptoms of osteoarthritis [19]. Another
study in 2007 showed that consultations for osteoarthritis
account for 15% of all musculoskeletal consultations in those
aged 45 and over, rising to 25% in those aged 75 and over
[20]. The cost per consultation is estimated at £36 for a 12-
minute consultation [21].
During the year from 1999-2000, there were 114,500
hospital admissions related to osteoarthritis in the UK
[17]. The latest Hospital Episode Statistics (HES) data
(2010-2011) have shown a significant increase in hospital
admissions, for hip and knee arthritis alone, the combined
figure was 181,350 admissions [20]. When the diagnoses
for polyarthritis and “other arthritis”–but not rheumatoid
conditions or crystal arthropathy are included, the total
number of admissions in 2010/11 was 207,041, representing
an 80% increase compared with figures of 10 years ago.
Surprisingly, there are no published studies in the liter-
ature with regard to direct or indirect costs of osteoarthritis
in the UK. Data, however, is instead only available from a
variety of other sources.
4.5. What Information Is Available from Other Sources about
Costs in the UK?
4.5.1. Direct Costs. The National Institute of Clinical Excel-
lence (NICE) recently published a costing report in 2008
with regard to implementing the guidelines for treatment
of osteoarthritis [22]. In the report, NICE estimated the
prevalence of osteoarthritis in the UK to be a total of 2.8
million patients, based on symptomatic diagnosis in patients
aged over 45. The analysis covered the management of
osteoarthritis in all such patients.
The cost of topical and oral nonsteroidal anti-
inflammatories (NSAIDs) was estimated using prescribing
data from 2005/06 [22]. An estimated 167 000 people
who had a diagnosis of osteoarthritis were found to have
been prescribed topical NSAIDs, and it was estimated that
50% (1.4 million patients) of patients with osteoarthritis
were prescribed oral NSAIDs. The annual cost in 2005/06
of prescribing topical NSAIDs was £8.5 million and £25
million for oral NSAIDs. The cost for topical NSAID
prescriptions was anticipated to double, and the cost of
oral treatment reduced by 10%, if the new guidelines are
followed. Adjusting for inflation, in 2010 prices, this would
equate to £19.2 million and £25.65 million, respectively.
The cost of iatrogenic events related to NSAID use is
also substantial. NSAID-related iatrogenic events have been
4Arthritis
estimated to be between £32–£70 per patient prescribed an
NSAID in the UK. This equates to a total cost of £44.8–£98
million per year (£56.9–£124.4 million at 2010 prices) [23].
The cost of proton pump inhibitor (PPIs) prescription
for use with NSAID treatment was £26 000 in 2005/06 but
expected to rise significantly to £10.5 million (£11.6 million
in 2010) with implementation of the new guidance.
The 2005/06 Hospital Episode statistics stated that the
total number of people aged 45 and over who received
arthroscopic lavage and debridement for knee osteoarthritis
was approximately 20 000. The national tarifor arthro-
scopies set by the Health Resource Group in 2008/09 was
£1264, resulting in a cost £25 million for such treatment.
It should be noted that NICE expected the cost of this
to fall dramatically (by 19000 patients), with guidelines
restricting the use of arthroscopic treatment to patients
with “mechanical” symptoms such as locking or giving way.
The new cost for arthroscopic treatment of osteoarthritis is
calculated (£1264 ×1000 patients) at £1.26 million (£1.3
million in 2010).
4.5.2. Economics of Joint Replacement. According to the 8th
annual report of the NJR, published September 2011 [22],
a 76 759 primary total hip replacements were performed
in 2010, a 6% increase from 2009. The revision “burden”
was approximately 11% with 7852 hips revised in 2010.
A total of 81979 knee replacements were done in 2010,
representing an increase of 5.7% when compared with 2009.
The revision “burden” here was less, at just over 6% requiring
revision in 2010. The proportion of total knee replacements
to unicondylar knee replacements and patella-femoral knee
replacements have remained largely the same for the last few
years.
While there are other causes for joint replacement
surgery, osteoarthritis remains the most frequent cause for
hip replacement (93% of primary hip replacements in 2010)
and knee replacement (97% of primary knee replacements in
2010).
The costs of hip and knee replacements vary considerably
from trust to trust in the UK with no set national price
for implants, and the cost also being significantly dependant
on length of hospital stay. The tarireimbursement paid
to the trust in one study [24] in 2005/06 was £6000 for
a primary total hip replacement and £6800 for a primary
total knee replacement. The national tarifor 2010 was set
at £5552 for an uncomplicated total hip replacement and
£5198 for a similar total knee replacement. This leads to an
estimated cost of £426 million for total hip replacements and
£426 million for primary total knee replacements, giving a
combined total cost for primary hip and knee replacements
of £852 million in 2010. This represents a substantial increase
in costs over the last 10 years, when compared to the
expenditure of £405 million in 2000 for 44 000 hip and 35
000 knee replacements [17]. Even adjusting for inflation, this
cost would only be £514 million in 2010, representing a 66%
increase in the last 10 years. Figure 1 summarises the UK
direct costs.
0
100
200
300
400
500
600
700
800
900
Millions £
NSAIDs
PPIs
Arthroscopy
NSAIDs
PPIs
NSAIDs iatrogenic
Arthroscopy
Joint replacement
NSAIDs
iatrogenic
Joint
replacement
Cost of OA in the UK
44.8 11.6 98 1.3
852
Figure 1
4.5.3. Indirect Costs. Osteoarthritis has a significant negative
impact on the UK economy with an estimated total cost of
1% of GNP [25]. The Department of Work and Pensions
estimates that 36 million work days were lost because
of osteoarthritis in 2002, resulting in a loss of economic
production over £3.2 billion; while at the same time, £43
million was spent on community services and £215 million
spent on social services for osteoarthritis [26].
Arthritis remains the most common condition for people
to receive the Disability Living Allowance (DLA), with £2.41
billion paid to people claiming incapacity benefit due to
arthritis and related conditions in 2001 [26]. More than half
a million people receive the DLA because of arthritis, more
than the total for heart disease, stroke, chest disease, and
cancer combined [16]. Only around 1 in 200 of those on
benefit later returns to work [27].
The most recent review of disability costs in the UK
was done by Dame Carol Black [28] in her review of the
health of the working age population. Unfortunately, the
review did not oer a breakdown of the components in
musculoskeletal disability costs, and so, despite the report,
the exact contribution of OA to such costs in the UK remains
unknown.
5. Discussion
The review demonstrates that osteoarthritis represents an
increasing economic burden to all countries, both from
direct costs and indirect costs. Economic data on osteoarthri-
tis has been made dicult because of problems defining the
prevalence and incidence of the disease. There is only sparse
literature available regarding economic costs in the east, but
what is more surprising is the lack of clear costing studies in
the west, especially in the UK.
Direct costs may vary from country to country, which is
to be expected given their dierent health systems, and even
between institutions in a country. Significant variability is
seen from these studies, making direct comparison dicult.
Compounding the problem is the fact that the methodology
Arthritis 5
Tab le 2
Author Year of study Country Cost studied
Individual cost per
annum (2010 £) per
OA patient
Population
cost per annum
(2010 £)
McClean et al. 1993 USA Direct costs £1526 US $548 million
Lanes et al. 1994 USA Direct costs £496 N/A
Buckwater et al. 2000 USA Indirect costs N/A £2 billion–£8 billion
Kotlartz et al. 2005 USA Indirect costs £355 £7.25 billion
Maetzel et al. 2000 Canada Direct costs
Indirect costs
£3162
£1407
N/A
N/A
Gupta et al. 2002 Canada Direct costs
Indirect costs
£1768
£9986
N/A
N/A
Loza et al. 2003 Spain Direct costs
Indirect costs
£1292
£209
£4.04 billion
£654 million
Le Pen et al. 2003 France Direct costs £316 £1.58 billion
Leardini et al. 2001 Italy Direct costs
Indirect costs
£ 981
£1299
N/A
N/A
Woo et al. 2001 Hong Kong Direct costs
Indirect costs
£6561
£620
£323 million
(combined cost)
Xie et al. 2005 Singapore Indirect costs £610–£730 N/A
used in estimating these costs can vary from study to study,
and not all studies give a clear breakdown of the calculation
of the direct costs involved [29].
Furthermore, in the studies that provide a breakdown of
the direct costs, few include the cost of alternative therapies
in the treatment of osteoarthritis. There is evidence that
nearly half (47%) of older patients in one American study
[30] used an alternative type of therapy, and these costs are
considerable (US$ 1127 or £723 per annum). Hence, the true
economic burden of direct costs in osteoarthritis is likely to
be significantly higher than most of these studies indicate.
The significant variability in indirect costs from these
studies is also a concern. This is likely to be due to the
lack of a standardized method to estimate indirect costs–
unfortunately, there remains at present no good evidence to
support one preferred method over the others [29]. Most
studies conclude that indirect costs, however, represent a
largely underestimated economic burden to country, and as
such, these estimates may just be the tip of the iceberg.
6. Conclusion
Our review of the literature suggests that while there are a
large number of studies on economic costs of osteoarthritis,
from multiple countries, the information available in the
literature remains patchy and dicult to interpret. Some
studies focus on the macroeconomic angle, looking at costs
at a national scale or costs per capita while others focus on
costs from the view of the individual patient with OA. Other
studies are only specific for arthritis of a single joint. Even
with studies compatible from this point of view, the varied
methodology and lack of standardization of costing make it
impossible to accurately compare economic costs, whether
direct or indirect. These studies are summarized in Tabl e 2.
Despite such diculties, one conclusion does seem clear
from these studies: that such costs are very substantial and
are continuing to rise.
The continuing lack of published data regarding direct
and indirect OA costs in the UK, especially from the patient
perspective, shows that more research into this area is vital.
This will allow us to fully appreciate the healthcare burden of
OAintheUK,aswellastomakemoreaccuratefinancial
planning for the provision for healthcare services for the
treatment of OA in the subsequent decade to come.
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... Acupuncture, which has been practiced for over 3,000 years, has shown potential to effectively manage chronic pain [26] [27]. ...
Article
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Introduction: Osteoarthritis is a common joint disease associated with aging, with knee osteoarthritis (KOA) affecting both elderly men and women in Indonesia. KOA is a major cause of disability and immobility, significantly impacting the quality of life of the elderly. Acupuncture is frequently used as a complementary and alternative medicine therapy to alleviate pain associated with KOA. This study aims to investigate the effect of acupuncture in relieving KOA-related pain in the elderly. Method: A pre-experimental study with a one-group pre-post-test design was conducted, involving 30 elderly respondents from the Payangan Desa hamlet, selected using purposive sampling. Data were collected using an observation sheet and the Comparative Pain Scale to evaluate pain levels. All respondents provided informed consent before participating in the study. The Wilcoxon Signed Rank Test was used to analyze and interpret the results. Result: Before the intervention, 9 respondents (30.0%) reported moderate knee pain, 10 (33.3%) reported severe pain, and 9 (30.0%) reported very severe pain. After the intervention, pain levels decreased significantly: 4 respondents (13.3%) reported no pain, 14 (46.7%) experienced mild pain, and 12 (40.0%) had moderate pain. The change in pain levels was statistically significant (p < 0.05). The median pain score decreased from Md = 5.50 before the intervention to Md = 2.00 after, with a z-value of -4.53 and r = 0.58. Conclusion: Acupuncture therapy is effective in alleviating pain levels among elderly individuals suffering from KOA-related pain, with no observed negative side effects. Acupuncture is a promising, safe, and effective alternative medicine for elderly patients with KOA.
... Osteoarthritis (OA) is one of the leading causes of disability worldwide, and costs the NHS over £3 billion annually [4]. It is a condition where joint cartilage degeneration causes pain and stiffness [3]. ...
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Menisci are cartilaginous tissue found within the knee that contribute to joint lubrication and weight dispersal. Damage to menisci can lead to onset and progression of knee osteoarthritis (OA), a condition that is a leading cause of disability, and for which there are few effective therapies. Accurate automated segmentation of menisci would allow for earlier detection and treatment of meniscal abnormalities, as well as shedding more light on the role the menisci play in OA pathogenesis. Focus in this area has mainly used variants of convolutional networks, but there has been no attempt to utilise recent large vision transformer segmentation models. The Segment Anything Model (SAM) is a so-called foundation segmentation model, which has been found useful across a range of different tasks due to the large volume of data used for training the model. In this study, SAM was adapted to perform fully-automated segmentation of menisci from 3D knee magnetic resonance images. A 3D U-Net was also trained as a baseline. It was found that, when fine-tuning only the decoder, SAM was unable to compete with 3D U-Net, achieving a Dice score of 0.81±0.030.81\pm0.03, compared to 0.87±0.030.87\pm0.03, on a held-out test set. When fine-tuning SAM end-to-end, a Dice score of 0.87±0.030.87\pm0.03 was achieved. The performance of both the end-to-end trained SAM configuration and the 3D U-Net were comparable to the winning Dice score (0.88±0.030.88\pm0.03) in the IWOAI Knee MRI Segmentation Challenge 2019. Performance in terms of the Hausdorff Distance showed that both configurations of SAM were inferior to 3D U-Net in matching the meniscus morphology. Results demonstrated that, despite its generalisability, SAM was unable to outperform a basic 3D U-Net in meniscus segmentation, and may not be suitable for similar 3D medical image segmentation tasks also involving fine anatomical structures with low contrast and poorly-defined boundaries.
... As the risk factors associated with the development of knee osteoarthritis increase, the incidence and prevalence of the condition will continue to rise. The increasing clinical burden of knee osteoarthritis is also associated with a high economic burden throughout the world [4][5][6]. A retrospective claims-based study published in 2017 estimated that direct annual costs of knee osteoarthritis in the USA (e.g., treatment, medical visits) incurred by patients ranged from $5.7 to 15 billion [5]. ...
Article
Full-text available
Purpose Corticosteroid injections are commonly used to treat symptomatic knee osteoarthritis; however, pain relief is usually transient. Genicular artery embolization (GAE) has shown promise as an effective minimally invasive intervention to alleviate symptomatic knee osteoarthritis. The MOTION study is being conducted to compare outcomes following GAE versus corticosteroid injection. Materials and Methods This is an international, multicenter, randomized controlled investigational device exemption (IDE) study enrolling adults (≥ 21 years old) with symptomatic knee osteoarthritis (Kellgren–Lawrence grades 1–4) across ≥ 45 centers worldwide. Patients will be randomized 1:1 to receive GAE with Embosphere® Microspheres (Merit Medical Systems, Inc.) or corticosteroid injections. The primary efficacy measure is clinical success at 6 months, defined as ≥ 50% improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale. The primary safety measure is the proportion of patients free from treatment-related safety event(s) through 6-month post-index procedure (GAE or corticosteroid injection). Following the 6-month visit, patients in either cohort who do not achieve clinical success may crossover to the other study arm. Additional study measures will assess safety and efficacy outcomes throughout the 24-month follow-up period. The target sample size is 264 (132 per arm) and is based on the number of patients needed to confirm superior efficacy of GAE versus corticosteroid injections and non-inferiority with respect to safety. The overall study power is > 80%. Discussion Findings from the MOTION study are expected to provide information on the magnitude of the therapeutic benefits associated with GAE versus standard of care over 24 months. Trial Registration NCT05818150. Graphical Abstract
... Meanwhile, outpatient expenditures remained consistently elevated across both models, indicating that OA continues to be a key contributor to outpatient costs. Although this is consistent with previous studies, direct comparisons could be complicated because of the health insurance system, methodologies, and data resources [4,[17][18][19]. ...
Article
Full-text available
Background This study investigated the association between healthcare utilization and expenditures, including non‐covered services in Korean older adults with osteoarthritis (OA). Methods This cross‐sectional study used data from the 2019 Korean Health Panel (KHP) annual data of participants aged ≥ 60 years who had OA. Healthcare utilization and expenditures were determined by hospitalization, outpatient, and emergency visits. A generalized linear model was used to examine healthcare utilization and expenditures associated with OA. Results Among the 5877 participants, 1645 (27.9%) had OA. Participants with OA had higher healthcare utilization (Increment = 6.5 visits, SE = 0.8, p < 0.0001) and expenditures (Increment = USD 432.8, SE = 111.8, p = 0.0001) compared to those without OA. The increase in utilization was primarily in outpatient visits (Increment = 6.4 visits, SE = 0.8, p < 0.0001), especially at clinics (Increment = 5.6 visits, SE = 0.9, p < 0.0001). Healthcare expenditures were also higher for both inpatient (Increment = USD 200.9, SE = 89.8, p = 0.0254) and outpatient visits (Increment = USD 236.6, SE = 51.7, p < 0.0001). Male with OA spent higher cost (USD 242.9) on outpatient visits than non‐OA participants. In contrast, females with OA reported higher expenditures for both inpatient (USD 301.3) and outpatient (USD 259.6) visits than those without OA. Conclusions OA was associated with a significant increase in healthcare utilization and expenditure. Appropriate strategies are required to reduce the burden of OA. Further study is required to explore how various healthcare facilities might be used together to provide safe and cost‐efficient treatment for OA patients within the healthcare system and in the community.
... Osteoarthritis is the most common musculoskeletal disease worldwide and represents a significant health and economic burden (8,9). It is a major cause of chronic pain and disability due to reduced joint mobility and function and reduced quality of life (10,11). Risk factors for osteoarthritis encompass genetic predispositions, lifestyle behaviors, biological factors such as age and gender, as well as metabolic conditions, including obesity and hypertension ( Figure 1) (12,13). ...
Article
Full-text available
Knee osteoarthritis (OA) is a common condition that causes pain and reduces the quality of life for many people. It also leads to high health and financial costs. Managing knee OA pain requires using different methods together for the best results. This review overviews current therapeutic options for knee OA pain, focusing on their efficacy, safety, and potential roles in clinical practice. Topical treatments, such as NSAIDs and capsaicin, offer significant pain relief with minimal systemic side effects and are suitable for initial therapy, together with nonpharmacologic interventions like exercise and, when relevant, weight loss. Oral analgesics, including acetaminophen and opioids, have limited efficacy and serious side effects, making them appropriate only for short-term or rescue therapy. Intra-articular injections, such as corticosteroids, hyaluronic acid, and platelet rich plasma, demonstrate varying levels of efficacy and safety. Nutritional supplements, including curcumin, Boswellia serrata, and glucosaminechondroitin combinations, offer modest benefits and are best used as adjuncts to standart treatment. Nonpharmacological treatments, such as transcutaneous electrical nerve stimulation (TENS), acupuncture, and local heat therapy, provide variable pain relief and should be customized based on individual patient responses. Targeted biologic agents, such as antibodies to TNF-α, IL-1, and NGF, hold promise for more precise pain relief; however, further research is required to establish their routine use. Treating knee OA pain should be personalized, combining several methods. Research must continue to improve treatments and make them safer.
... Conservative management of OA knee includes medications and physiotherapy [10]. On the surgical side, total knee replacement (TKR) is a proven effective treatment of OA knee known to provide substantial symptomatic relief, therefore leading to considerable patient satisfaction and improved quality of life [11]. TKR has been applied to treat OA knee for a considerable period. ...
Article
Full-text available
This study is an economic evaluation of total knee replacement (TKR) in comparison with non-surgical management in India. Cost-utility analysis and budget impact analysis (BIA) were conducted on individuals aged ≥ 50 years with osteoarthritis of the knee (OA knee) Kellgren-Lawrence grades 2 and 3 using a provider’s perspective. Three scenarios were considered, varying the age at which TKR is administered while assuming a 20-year lifespan for the implant. A Markov model was used to determine incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was conducted incorporating implant costs and other input parameters. Net quality-adjusted life-years (QALYs) gained per OA knee treated with TKR were superior when performed at the age of 50, regardless of OA severity and across all scenarios. The lowest ICER was 36,107 Indian National Rupees (INR) (USD 482.9)/QALY gained, observed at 50 years, while the highest was INR 61,363 (USD 820.72)/QALY gained at 70 years for grade-2 severity. Sensitivity analysis revealed that the ICER was most sensitive to the cost of non-surgical management, health utility values gained in an improved state, and the cost of TKR across scenarios. For the BIA in Scenario 1, with 40% coverage for TKR, costs reach INR 5013 crores (cr) (USD 670,477,060) in 2023 and INR 8444 cr (USD 1,024,628,736) in 2028 (1% of government budgets). In Scenario 2 (full coverage), costs are INR 12,532 cr (USD 1,520,683,008) (2.7%) in 2023, declining to 2.4% in 2028. In Scenario 3, covering 40% under the National Health Mission (NHM), costs vary from 17% in 2023 to 25% in 2028. This study concludes that TKR is a cost-effective treatment option compared with non-surgical management for OA knee in India, irrespective of age, implant types, and severity.
... Costs of medications used, blood and blood products transfusion and medical tests will also decrease in correlation with bed fee cost. In the UK, the total health care cost of osteoarthritis is estimated at over £1 billion (2010 prices) 22,26 . Based upon national survey data, Kortlarz et al. estimate the increased insurer expenditure for women in the US with osteoarthritis to be $4,833. ...
Article
Background and study aims: While working with increasing costs, hospital enterprises try to develop strategies to provide high quality services. In this study, we intended to perform the cost analysis of total knee arthroplasty. Materials and Methods: A total of 503 patients who were treated with total knee arthroplasty surgery due to gonarthrosis at Nev?ehir State Hospital Orthopedics and Traumatology clinic were included in the study. Procedures performed while the patient is in hospital were analyzed by dividing them into the costs of the implant applied to the patient, surgical procedure, medications used, blood and blood products transfusion, medical tests, anesthesia procedure, bed fee and other applied procedures. Results: The mean total cost was 7560.2 Turkish Lira (TL). The mean cost of the implant applied to the patient was 4847.7 TL, that of surgical procedure was 1800 TL, medications used 371.1 TL, blood and blood products transfusion 38.7 TL, medical tests 38.3 TL, anesthesia procedures 142.7 TL, bed fee 195.2 TL and other applied procedures 122.9 TL. Conclusion: In the cost analyses made in this study, it is observed that the share of implant, surgical procedure and anesthesia costs within the total cost is approximately 90%. It is not possible to cut back on the producedures in this 90% part and to modify them. To reduce the total cost, it seems most reasonable to focus on the costs of blood and blood products transfusion, medical tests, medications used and bed fees.
Article
Background and Aims Due to the importance of proprioception and pain in determining the quality of life and independence of people with knee osteoarthritis (KOA), this study aims to assess the effect of water-based neuromuscular exercises on knee joint proprioception and pain in women with second and third knee osteoarthritis. Methods In this randomized clinical trial, 24 older women with KOA participated. They were randomly divided into two groups of 2nd-grade KOA (n=12) and 3rd-grade KOA (n=12). Before and after eight weeks of neuromuscular training protocol in water, the digital photography method was used to measure the amount of changes in the knee joint proprioception, and the first section of the Knee Injury and Osteoarthritis Outcome Score was utilized to measure the knee pain. The data were analyzed using repeated measures ANOVA. Results There were significant differences between the pre-test and post-test phases in the 2nd KOA group (P=0.001 for proprioception, P=0.044 for pain) and the 3rd grade KOA group (P=0.018 for proprioception, P=0.001 for pain). There were no significant differences between the two groups. Conclusion The eight weeks of water-based neuromuscular exercises may improve the knee joint proprioception and reduce knee pain in older women with 2nd/3rd grade KOA. There women are recommended to use these exercises.
Article
Purpose Hip osteoarthritis (OA) is a common disabling musculoskeletal condition. Clinical guidelines recommend intra‐articular corticosteroid injections (IACSI) as a pharmacological adjunct to help manage pain. IACSI are typically image‐guided either by ultrasound guidance (USG) or fluoroscopic guidance (FG) with no clear evidence towards the more efficacious guidance technique. This study aims to systematically review the scientific literature to determine the clinical effectiveness of USG compared with FG‐IACSIs for people with pain‐related hip OA. Methods A systematic review of major bibliographic databases from inception to 24 August 2023 was conducted. Randomised controlled trials of USG‐ and FG‐IACSIs for patients with hip OA were included. The primary outcome measure was pain. Hedges' g calculated effect size and meta‐analysis using the random‐effects model‐estimated pooled effect sizes. τ ² , I ² and Cochran's Q calculated heterogeneity. Network meta‐analysis was completed to indirectly compare effect sizes. Quality was assessed using the Cochrane risk‐of‐bias tool (RoB2). Results A total of 1464 citations were identified; eight studies were included in the review. No studies directly compared imaging modalities. Two network meta‐analyses indirectly comparing USG‐ to FG‐IACSI via an image‐guided comparator hip injection ([any comparator], [local anaesthetic or saline]) established effect sizes (g) of 2.61 and 2.46, respectively, both in favour of FG‐IACSI. Heterogeneity was low in the USG studies and high in the FG studies. Conclusion(s) Evidence suggests that both USG and FG‐IACSI are effective at reducing pain at 1 month in patients with painful hip OA. Although network meta‐analyses favoured FG‐IACSI, further high‐quality trials are needed to determine the preferred guidance technique.
Article
Full-text available
Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with gastrointestinal problems, notably dyspepsia and bleeding. These adverse effects are costly both in terms of acute hospital admissions and in co-prescribing of gastroprotective agents. The costs of these interventions has been estimated for the National Health Service (NHS) in the UK on the basis of a typical Primary Care Group (PCG) of 100,000 people, the whole population, and for the average patient prescribed an NSAID. The annual burden of NSAID-related gastrointestinal adverse effects to the NHS is large. The middle estimate for an average PCG was £435,000 (range £290,000 to £633,000). The middle estimate for the UK was £251 million (range £166 million to £367 million). The middle cost per patient prescribed an NSAID was £48 (range £32 to £70). As much as half of all acid-suppressing prescribing in the UK may be for NSAID-related gastrointestinal effects.
Article
Objective: To describe current clinical practice against the BSPAR/ARMA Standards of Care (SOCs) for children and young people (CYP) with incident JIA. Methods: Ten UK paediatric rheumatology centres (including all current centres nationally accredited for paediatric rheumatology higher specialist training) participated in a retrospective case notes review using a pretested pro forma based on the SOC. Data collected per centre included clinical service configuration and the initial clinical care for a minimum of 30 consecutive new patients seen within the previous 2 years and followed up for at least 6 months. Results: A total of 428 CYP with JIA (median age 11 years, range 1-21 years) were included, with complete data available for 73% (311/428). Against the key SOCs, 41% (175/428) were assessed ≤10 weeks from symptom onset, 60% (186/311) ≤4 weeks from referral, 26% (81/311) had eye screening at ≤6 weeks, 83% (282/341) had joint injections at ≤6 weeks, 59% (184/311) were assessed by a nurse specialist at ≤4 weeks and 45% (141/311) were assessed by a physiotherapist at ≤8 weeks. A median of 6% of patients per centre participated in clinical trials. All centres had access to eye screening and prescribed biologic therapies. All had access to a nurse specialist and physiotherapist. Most had access to an occupational therapist (8/10), psychologist (8/10), joint injection lists (general anaesthesia/inhaled analgesia) (9/10) and designated transitional care clinics (7/10). Conclusion: This first description of UK clinical practice in paediatric rheumatology benchmarked against the BSPAR/ARMA SOCs demonstrates variable clinical service delivery. Considerable delay in access to specialist care is evident and this needs to be addressed in order to improve clinical outcomes.
Article
Abstract OBJECTIVE: To estimate the direct and indirect osteoarthritis (OA)-attributable costs and predictors of costs of knee and hip OA in Spain. METHODS: This study included consecutive patients age > or = 50 years with symptomatic and radiologic knee and/or hip OA who were seen at primary care centers in all provinces of Spain. Information on demographics, health status (Short Form 12 Health Survey), comorbidities (Charlson Index), clinical (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and radiologic OA severity (Kellgren/Lawrence [K/L] scale), data related to OA health resources utilization (medical and nonmedical), and subjects' and caregivers' expenses and time lost in the previous 6 months were collected in 2 separate, structured, and detailed interviews. Costs in euros were assigned using market prices and official sources if available, and were annualized (to 2007). The predictors of costs were assessed in multivariate regression models. Costs were log-transformed before being modeled. RESULTS: A total of 1,071 subjects were analyzed (74% women, mean +/- SD age 71 +/- 9 years). Average total annual costs were euro1,502 per patient. Direct costs accounted for 86% of the total cost. We estimated a national cost of euro 4,738 million, representing 0.5% of the gross national product. Higher total costs were associated with comorbidity (Charlson Index odds ratio [OR] 1.27, 95% confidence interval [95% CI] 1.03-1.58), poorer health status (P < 0.050), worse WOMAC scores (OR 1.05, 95% CI 1.03-1.08), and grade 4 K/L scores (OR 1.76, 95% CI 1.15-2.69). CONCLUSION: The economic burden of knee and hip OA is substantial. Costs increased with comorbidity, poorer health status, and clinical and radiologic OA severity.
Article
Osteoarthritis, the clinical syndrome of joint pain and dysfunction caused by joint degeneration, affects more people than any other joint disease. There are no consistently effective methods for preventing osteoarthritis or slowing its progression, and symptomatic treatments provide limited benefit for many patients. Osteoarthritis disables about 10% of people who are older than 60 years, compromises the quality of life of more than 20 million Americans, and costs the United States economy more than $60 billion per year. The incidence of osteoarthritis rises precipitously with age; as a result, the prevalence and burden of this disorder is increasing rapidly. Study of the patterns osteoarthritis incidence and prevalence shows that it occurs frequently in the hand, foot, knee, spine and hip, but rarely in the ankle, wrist, elbow, and shoulder, and the most important universal risk factors are age, excessive joint loading, and joint injury. Analysis of the impact of osteoarthritis raises questions that include: Why does the incidence increase progressively with age? Why are some joints rarely affected? How do mechanical forces cause joint degeneration? What biologic and mechanical factors slow or accelerate the rate of joint degeneration? Answering these questions could lead to effective methods of preventing osteoarthritis and slowing its progression.
Article
To investigate the prevalence of osteoarthritis (OA) of the knee in elderly subjects, we studied the Framingham Heart Study cohort, a population-based group. During the eighteenth biennial examination, we evaluated the cohort members for OA of the knee by use of medical history, physical examination, and anteroposterior (standing) radiograph of the knees. Radiographs were obtained on 1,424 of the 1,805 subjects (79%). Their ages ranged from 63–94 years (mean 73). Radiographs were read by a radiologist who specializes in bone and joint radiology, and were graded 0–4 according to the scale described by Kellgren and Lawrence. OA was defined as grade 2 changes (definite osteophytes), or higher, in either knee. Radiographic evidence of OA increased with age, from 27% in subjects younger than age 70, to 44% in subjects age 80 or older. There was a slightly higher prevalence of radiographic changes of OA in women than in men (34% versus 31%); however, there was a significantly higher proportion of women with symptomatic disease (11% of all women versus 7% of all men; P = 0.003). The age-associated increase in OA was almost entirely the result of the marked age-associated increase in the incidence of OA in the women studied. This study extends current knowledge about OA of the knee to include elderly subjects, and shows that the prevalence of knee OA increases with age throughout the elderly years.
Article
Objective To examine the rates of use and expenditures on alternative therapies by adults with osteoarthritis (OA).Methods Adults with OA recruited from the community to participate in a randomized clinical trial recorded alternative and traditional health care use on postcard diaries. General and arthritis-specific quality of life was assessed by questionnaires.ResultsMore than 47% of participants reported using at least one type of alternative care during the 20-week intervention period. Among alternative care consumers, the most commonly used treatments were massage therapy (57%), chiropractic services (20.7%), and nonprescribed alternative medications (17.2%). Four percent of subjects reported using only alternative care during the study period. Expenditures for alternative therapy averaged 1,127peryear,comparedwith1,127 per year, compared with 1,148 for traditional therapies.Conclusion Use of and expenditures for alternative care were high among this cohort of older adults with OA. Clinicians may want to inquire about use of these therapies before recommending treatments for this condition.
Article
Objectives: To estimate indirect costs through human capital approach and intangible costs through willingness-to-pay (WTP), and identify factors potentially affecting these costs in multiethnic Asian patients with knee osteoarthritis (OA). Methods: Data were collected through face-to-face interviews among knee OA patients. Human capital approach was used to estimate indirect costs by multiplying: 1) days of absence from work because of OA, with average earnings per capita per day for working patients; or 2) productivity loss with the market price of housekeeping for retirees/homemakers. A closed-ended iterative bidding contingent valuation method was used to elicit willingness-to-pay for a hypothetical cure of OA as a proxy for intangible costs. Mann-Whitney U or Kruskal-Wallis H-tests were performed in univariate analyzes, and linear regression in multivariate analyses. Results: Indirect costs per year and intangible costs were estimated at US1008andUS1008 and US1200, accounting for 2.8% and 3.3% of annual household income, respectively. The indirect costs were significantly higher for male or working patients, while intangible costs were higher for Chinese, working patients, with higher income, or worse global well-being. Conclusion: This study demonstrated that eliciting indirect costs through human capital approach and intangible costs through WTP are acceptable and feasible in Asian patients with knee OA. Besides the direct costs, the indirect and intangible costs for the OA patients could be substantial.