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The Global Economic Cost of Osteoarthritis: How the UK Compares

  • 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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Volume 2012, Article ID 698709, 6pages
Review Article
The Global Economic Cost of Osteoarthritis:
How the UK Compares
Correspondence should be addressed to A. Chen,
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
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.
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
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
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
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
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
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
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
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.
Millions £
NSAIDs iatrogenic
Joint replacement
Cost of OA in the UK
44.8 11.6 98 1.3
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
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
cost per annum
(2010 £)
McClean et al. 1993 USA Direct costs £1526 US $548 million
Lanes et al. 1994 USA Direct costs £496 N/A
Buckwater et al. 2000 USA Indirect costs N/A £2 billion–£8 billion
Kotlartz et al. 2005 USA Indirect costs £355 £7.25 billion
Maetzel et al. 2000 Canada Direct costs
Indirect costs
Gupta et al. 2002 Canada Direct costs
Indirect costs
Loza et al. 2003 Spain Direct costs
Indirect costs
£4.04 billion
£654 million
Le Pen et al. 2003 France Direct costs £316 £1.58 billion
Leardini et al. 2001 Italy Direct costs
Indirect costs
£ 981
Woo et al. 2001 Hong Kong Direct costs
Indirect costs
£323 million
(combined cost)
Xie et al. 2005 Singapore Indirect costs £610–£730 N/A
used in estimating these costs can vary from study to study,
and not all studies give a clear breakdown of the calculation
of the direct costs involved [29].
Furthermore, in the studies that provide a breakdown of
the direct costs, few include the cost of alternative therapies
in the treatment of osteoarthritis. There is evidence that
nearly half (47%) of older patients in one American study
[30] used an alternative type of therapy, and these costs are
considerable (US$ 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
planning for the provision for healthcare services for the
treatment of OA in the subsequent decade to come.
[1] A. D. Woolf and B. Pfleger, “Burden of major musculoskeletal
conditions,Bulletin of the World Health Organization, vol. 81,
no. 9, pp. 646–656, 2003.
[2] C. J. L. Murray and A. D. Lopez, “Global mortality, disability,
and the contribution of risk factors: global burden of disease
study,The Lancet, vol. 349, no. 9063, pp. 1436–1442, 1997.
[3] F. Xie, J. Thumboo, K. Y. Fong et al., “A study on indirect
and intangible costs for patients with knee osteoarthritis in
Singapore,Value in Health, vol. 11, no. 1, pp. 84–90, 2008.
[4] R. C. Lawrence, D. T. Felson, C. G. Helmick et al., “Estimates
of the prevalence of arthritis and other rheumatic conditions
in the United States. Part II,Arthritis and Rheumatism, vol.
58, no. 1, pp. 28–35, 2008.
[5] D. T. Felson, A. Naimark, and J. Anderson, “The preva-
lence of knee osteoarthritis in the elderly. The Framingham
Osteoarthritis study,Arthritis and Rheumatism,vol.30,no.8,
pp. 914–918, 1987.
[6] M. Lethbridge-C¸ ejku, C. G. Helmick, and J. R. Popovic,
“Hospitalizations for arthritis and other rheumatic conditions
data from the 1997 National Hospital Discharge survey,”
Medical Care, vol. 41, no. 12, pp. 1367–1373, 2003.
[7] I. Rosemont, United States Bone and Joint Decade. The Burden
of Musculoskeletal Diseases in the United States,American
Academy of Orthopaedic Surgeons, Rosemont, Ill, USA, 2008.
[8] J. A. Buckwalter, C. Saltzman, and T. Brown, “The impact of
osteoarthritis: implications for research,Clinical Orthopae-
dics and Related Research, supplement 427, pp. S6–S15, 2004.
[9] H. Kotlarz, C. L. Gunnarsson, H. Fang, and J. A. Rizzo,
“Osteoarthritis and absenteeism costs: evidence from US
national survey data,Journal of Occupational and Environ-
mental Medicine, vol. 52, no. 3, pp. 263–268, 2010.
[10] S. Gupta, G. A. Hawker, A. Laporte, R. Croxford, and P.
C. Coyte, “The economic burden of disabling hip and knee
osteoarthritis (OA) from the perspective of individuals living
with this condition,Rheumatology, vol. 44, no. 12, pp. 1531–
1537, 2005.
[11] L. M. March and C. J. M. Bachmeier, “Economics of osteoar-
thritis: a global perspective,Bailliere’s Clinical Rheumatology,
vol. 11, no. 4, pp. 817–834, 1997.
[12] E.Loza,J.M.Lopez-Gomez,L.Abasolo,J.Maese,L.Carmona,
and E. Batlle-Gualda, “Economic burden of knee and hip
osteoarthritis in Spain,Arthritis Care and Research, vol. 61,
no. 2, pp. 158–165, 2009.
[13] C. Le Pen, C. Reygrobellet, and I. G´
erentes, “Financial cost
of osteoarthritis in France: the “COART” France study,Joint
Bone Spine, vol. 72, no. 6, pp. 567–570, 2005.
[14] E. Levy, A. Ferme, D. Perocheau, and I. Bono, “Socioeconomic
costs of osteoarthritis in France,Revue du Rhumatisme, vol.
60, no. 6, pp. 63S–67S, 1993.
[15] G. Leardini, F. Sala,R.Caporali,B.Canesi,L.Rovati,andR.
Montanelli, “Direct and indirect costs of osteoarthritis of the
knee,Clinical and Experimental Rheumatology, vol. 22, no. 6,
pp. 699–706, 2004.
[16] J. Woo, E. Lau, C. S. Lau et al., “Socioeconomic impact of
osteoarthritis in Hong Kong: utilization of health and social
services, and direct and indirect costs,Arthritis Care and
Research, vol. 49, no. 4, pp. 526–534, 2003.
[17] A. R. Council, 2002, Arthritis: The Big Picture, http://www.
[18] S. R. Pye, D. M. Reid, R. Smith et al., “Radiographic features of
lumbar disc degeneration and self reported back pain,Journal
of Rheumatology, vol. 31, no. 4, pp. 753–758, 2004.
[19] Royal College of General Practitioners—Birmingham
Research Unit, “Annual prevalence report,” Tech. Rep., 2006.
[20] HES,
er?siteID=1937&categoryID=203, 2011.
[21] L. Curtis, Unit Costs of Health and Social Care 2009, Personal
Social Services Research Unit, The University of Kent, Kent, UK.
[22] N. J. Registry, 8th Annual Report. 2011.
[23] R. A. Moore and C. J. Phillips, “Cost of NSAID adverse
eects to the UK national health service,Journal of Medical
Economics, vol. 2, pp. 45–55, 1999.
[24] P. Hamilton, M. Lemon, Field, and R. Issue, “Cost of total
hip and knee arthroplasty in the UK. A comparison with the
current reimbursement system in the NHS,JournalofBone
and Joint Surgery B, vol. 91, supplement 1, article 112, 2009.
[25] H. Arthritis, Arthrtitis in the UK—the Key Facts, 2008.
[26] UK, D. F. w. and P., Disability Living Allowance—cases in
payment Caseload (Thousands): Main Disabling Condition
by Gender of claimant,
bled/ccsex/a carate rdisabled cccsex nov07.html, 2007.
[27] Arthritis and Musculoskeletal Alliance. Standards of care for
people with osteoarthritis,
[28] D. C. Black, Working for a Healthier Tomorrow, Transaction,
London, UK, 2008.
[29] F. Xie, J. Thumboo, and S. C. Li, “True dierence or something
else? Problems in cost of osteoarthritis studies,Seminars in
Arthritis and Rheumatism, vol. 37, no. 2, pp. 127–132, 2007.
[30] S.D.Ramsey,A.C.Spencer,T.D.Topolski,B.Belza,andD.
L. Patrick, “Use of alternative therapies by older adults with
osteoarthritis,Arthritis Care and Research,vol.45,no.3,pp.
222–227, 2001.
... The societal economic burden can be described in terms of costs related to healthcare resource use (direct costs), and costs related to productivity loss due to work absence (indirect costs). Two systematic literature reviews found the estimated annual cost of OA per patient to be between €430 and €11,443 for direct costs and €210-€13,577 for indirect costs [10,11] (all presented costs have been converted to 2019 EUR). The results of these two studies highlight the variation and main drivers of cost estimates of OA due to differences in study design and included cost categories. ...
... Previous studies in the Nordics have estimated the corresponding total annual cost of OA to between €0.6 and €1.1 billion [13][14][15]. Higher OA pain severity has been shown to be associated with increased healthcare resource use, absenteeism and presenteeism, and early retirement [10]. However, the limitations in the studies that have been conducted to date include small sample sizes, selected subgroups of OA patients, using survey data and/or top-down approaches [10][11][12][13][14][15][16]. ...
... Higher OA pain severity has been shown to be associated with increased healthcare resource use, absenteeism and presenteeism, and early retirement [10]. However, the limitations in the studies that have been conducted to date include small sample sizes, selected subgroups of OA patients, using survey data and/or top-down approaches [10][11][12][13][14][15][16]. ...
Data from 'BISCUITS', a large Nordic cohort study linking several registries, were used to estimate differences in average direct and indirect costs between patients with osteoarthritis and controls (matched 1:1 based on birth year and sex) from the general population in Sweden, Norway, Finland and Denmark for 2017. Patients ≥18 years with ≥1 diagnosis of osteoarthritis (ICD-10: M15-M19) recorded in specialty or primary care (the latter available for a subset of patients in Sweden and for all patients in Finland) during 2011-2017 were included. Patients with a cancer diagnosis (ICD-10: C00-C43/C45-C97) were excluded. Productivity loss (sick leave and disability pension) and associated indirect costs were estimated among working-age adults (18-66 years). In 2017, average annual incremental direct costs among adults with osteoarthritis (n=1,157,236) in specialty care relative to controls ranged between €1,259 and €1,693 (p<0.001) per patient across all countries. Total average annual incremental costs were €3,224-€4,969 (p<0.001) per patient. Healthcare cost differences were mainly explained by osteoarthritis patients having more surgeries. However, among patients with both primary and secondary care data, primary care costs exceeded the costs of surgery. Primary care constituted 41 and 29 % of the difference in direct costs in Sweden and Finland, respectively. From a societal perspective, the total economic burden of osteoarthritis is substantial, and the incremental cost was estimated to €1.1-€1.3 billion yearly for patients in specialty care across the Nordic countries. When including patients in primary care, incremental costs rose to €3 billion in Sweden and €1.8 billion in Finland. Given the large economic impact, finding cost-effective and safe therapeutic strategies for these patients will be important.
... Although osteoarthritis can occur in any joint in the body, it most frequently occurs in the knee joint, accounting for 365 million cases worldwide and 61% of YLDs lost to knee osteoarthritis, followed by hand osteoarthritis (142 million cases and 24% YLD osteoarthritis) and hip osteoarthritis (33 million and 5.5% of OA YLDs) [5,6,13,14]. As demonstrated by the Vietnam Musculoskeletal Association, the prevalence of arthritis in people over 35 years old is about 30%, while in people over 65 years old, it is about 60%, and it reaches 85% in people over 80 years old [15]. Based on a study conducted in 2003, the proportion of musculoskeletal pain in the urban population in Vietnam was 14.5% and OA was the most common form of arthritis [16]. ...
... The indirect costs of treating osteoarthritis are also significant. Published estimates of the indirect costs of osteoarthritis in different established market economies include Spain (USD 1.2 billion), the United Kingdom (USD 6.5 billion), and the United States (USD 12.7 billion) [35,36]. ...
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Osteoarthritis (OA) is a chronic condition that most frequently affects older adults. It is currently the most common disability. The cost of treating an aging population places pressure on the healthcare budget. As a result, it is imperative to evaluate medicines’ cost-effectiveness and, accordingly, their influence on health resource allocation. Our study aims to summarize the cost and outcome of utilizing glucosamine in OA treatment. Databases like Medline, Cochrane, and Scopus were searched as part of the identification process up until April 2023. Our primary inclusion criteria centered on the economic evaluation of glucosamine in OA treatments, providing an incremental cost-effectiveness ratio (ICER). The Quality of Health Economic Studies (QHES) instrument was applied to grade the quality of the studies. Seven qualified studies that discussed the cost-effectiveness of glucosamine with or without other formulations were selected. All of them demonstrated that glucosamine was cost-effective. There was an increase in quality-adjusted life years (QALYs) when incorporating glucosamine in conventional care. Moreover, patented crystalline glucosamine sulfate (pCGS) was more cost-effective than the other formulations of glucosamine (OFG). Overall, utilizing pCGS was more beneficial than using OFG in terms both of cost and quality of life.
... The rising prevalence of chronic conditions, such as OA, increases the burden on the health system, especially in primary care settings where most of these conditions are managed. OA incurs a large expenditure in primary care and is a financial burden to health systems worldwide (5,6). In addition to clinical need, health care utilisation in primary care depends on a wide range of factors such as socioeconomic and demographic factors, accessibility, and availability (7). ...
... Descriptive statistics of each outcome were reported as either mean (standard deviation (SD)) or median (inter quartile range (IQR)) as per distribution. Normal distribution of outcomes was checked 6 using histograms and the Shapiro-Wilk test. Primary care consultations were grouped into four equal groups using quartiles, i.e., 25% participants per group. ...
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Background: The burden of osteoarthritis (OA) in UK primary care has not been investigated thoroughly. Aim: To estimate healthcare use and mortality in people with OA (overall and joint specific). Design and setting: A matched cohort study of adults with an incident diagnosis of OA in primary care were selected for the study using UK national Clinical Practice Research Datalink (CPRD) electronic records. Method: Healthcare utilisation was measured as the annual average number of primary care consultations and admissions to hospital after the index date for any cause and all-cause mortality data in 221 807 people with OA and an equal number of controls (with no OA diagnosis) who were matched to the case patients by age (standard deviation 2 years), sex, practice, and year of registration. The associations between OA and healthcare utilisation and all-cause mortality were estimated using multinomial logistic regression and Cox regression, respectively, adjusting for covariates. Results: The mean age of the study population was 61 years and 58% were female. In the OA group, the median number of primary care consultations per year after the index date was 10.91 compared with 9.43 in the non-OA control group (P = 0.001) OA was associated with an increased risk of GP consultation and admission to hospital. The adjusted hazard ratio for all-cause mortality was 1.89 (95% confidence interval [CI] = 1.85 to 1.93) for any OA, 2.09 (95% CI = 2.01 to 2.19) for knee OA, 2.08 (95% CI = 1.95 to 2.21) for hip OA, and 1.80 (95% CI = 1.58 to 2.06) for wrist/hand OA, compared with the respective non-OA control group. Conclusion: People with OA had increased rates of GP consultations, admissions to hospital, and all-cause mortality that varied across joint sites.
... The indirect costs of treating osteoarthritis are also significant. Published estimates of the indirect costs of osteoarthritis in different established market economies include Spain ($1.2 billion), United Kingdom ($6.5 billion), billion) and the United States ($12.7 billion) [35,36]. ...
Full-text available
The osteoarthritis (OA), the main cause of disability, is a chronic condition that most frequently affects older adults. As the population ages, the cost of treatment is placing pressure on the healthcare budget. As a result, it is imperative to evaluate the medicines' cost-effectiveness and the influence they have on health resource allocation. Hence, our study aims to summarize the cost and outcome of utilizing glucosamine in OA treatment. Authentic databases like Medline, Cochrane, and Scopus were adopted for the identification process up until July 2023. Our primary inclusion criteria centered on the economic evaluation of Glucosamine in OA treatments with provided the incremental cost-effectiveness ratio (ICER) at least. The Quality of Health Economic Studies (QHES) instrument was applied to grade the quality of the studies. A total of 7 qualified studies were selected and discussed the cost-effectiveness of glucosamine with or without other formulations. All of them demonstrated that glucosamine was cost-effective. There was an in-creasement of QALY when incorporating Glucosamine into conventional care. Moreover, Crystalline Glucosamine Sulfate (pCGS) was more cost-effective than the Other Formulations of Glucosamine (OFG). In overall, utilizing pCGS was more beneficial than OFG in terms both of cost and quality of life.
... Il principale driver dei costi sanitari è l'intervento chirurgico ovvero il punto terminale della storia clinica dell'OA (11). L'incremento dell'incidenza dell'OA, specie a livello di ginocchio e anca, dovuta alla crescita dei fattori di rischio come l'invecchiamento della popolazione e l'obesità, sta comportando un conseguente aumento del numero di interventi di artroprotesi e una crescita continua dei costi legati alla patologia (12,13). ...
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Purpose The increasing incidence of total joint arthroplasty reflects the rises of osteoarthritis (OA) prevalence. OA is a degenerative pathology affecting joints with a significant impact on quality of life causing pain, leading to social life limitations and loss of work productivity. According to the World Health Organization, OA is one of the most important causes of people's disability. The burden of the disease is correlated with a huge economic impact on the health care systems. Intra-articular infiltration therapies are used between the pharmacological and the surgical phases, in order to delay surgery. This work aims to carry out an economic evaluation on the use of the Platelet-Rich-Plasma (PRP) therapy in the treatment of knee OA. The comparator is the hyaluronic acid, i.e. the standard therapy for drug-resistant OA that does not benefit or has short term benefits (
... OA is the most common musculoskeletal disorder worldwide, and it poses a huge health and economic burden. It is considered a major cause of chronic pain, disability -due to diminished joint mobility and function-, and decreased quality of life [8,9]. Thus, finding effective and safe therapies for the treatment of OA is a significant clinical need. ...
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Osteoarthritis (OA) is the most common musculoskeletal disease, and it is a major cause of pain, disability and health burden. Pain is the most common and bothersome presentation of OA, but its treatment is still suboptimal, due to the short-term action of employed analgesics and their poor adverse effect profile. Due to their regenerative and anti-inflammatory properties, mesenchymal stem cells (MSCs) have been extensively investigated as a potential therapy for OA, and numerous preclinical and clinical studies found a significant improvement in joint pathology and function, pain scores and/or quality of life after administration of MSCs. Only a limited number of studies, however, addressed pain control as the primary end-point or investigated the potential mechanisms of analgesia induced by MSCs. In this paper, we review the evidence reported in literature that support the analgesic action of MSCs in OA, and we summarize the potential mechanisms of these antinociceptive effects Almahasneh F, Abu-El-Rub E, Khasawneh RR. Mechanisms of analgesic effect of mesenchymal stem cells in osteoarthritis pain. World J Stem Cells 2023; 15(4): 196-208 [DOI: 10.4252/wjsc.v15.i4.196]
... OA has a huge impact economically, in addition to its effect on health. In the United States, the annual cost of joint replacement for OA was estimated at $22.6 billion, and the job-related OA cost was approximately $13.2 billion (4,5). ...
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The association between dietary macronutrient distribution and the risk of OA remains unknown. We aimed to evaluate how dietary macronutrient distribution was correlated with the risk of OA in US adults. We performed a cross-sectional study consisting of 7,725 participants from National Health and Nutrition Examination Survey (NHANES) 2013-2016. Dietary macronutrient intake and OA status were assessed by using dietary recall method and self-reported questionnaire, respectively. We evaluated the association between dietary macronutrient distribution and the risk of OA using multivariate regression models. We conducted the isocaloric substitution analysis using the multivariate nutrient density method. Higher percentage of energy intake from fat was associated with higher risk of OA [OR = 1.05 (95% CI, 1.00, 1.09); P = 0.034]. No significant correlation was observed between the percentage of energy intake from carbohydrate or protein and risk of OA. Isocaloric substitution analysis revealed that only the substitution between fat and carbohydrate was significantly associated with the risk of OA [OR = 1.05 (95% CI, 1.003 to 1.09); P = 0.037]. Our findings suggested that a diet with low percentage of energy intake from fat may be beneficial in the prevention of OA. Further prospective cohort studies are needed to assess our results.
... Furthermore, the longer life expectancy in areas with higher SDI can result in older societies with more aged people to be at risk of knee OA [12]. Economic impacts of knee OA is not limited to its direct costs, such as costs of surgery and pharmacological treatment, but also encompass a wide range of indirect and intangible costs, including loss of productivity, pain and suffering, absenteeism, decreased quality of life, and depression [6]. It is projected that, in the US, near $3.4 to $13.2 billion is devoted to job-related OA costs each year [5]. ...
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Background Knee is the most affected joint in osteoarthritis (OA) and accounts for almost four-fifths of the burden of OA globally. We aimed to explore the prevalence, incidence, trends, and burden of knee OA during 1990–2019 in the Middle East and North Africa (MENA) region, using the Global Burden of Disease (GBD) study data. Methods This is an epidemiological study based on the GBD data from 1990 to 2019 on knee OA in MENA countries. The prevalence, incidence, and years lived with disability (YLD) numbers of knee OA were obtained for both genders. Similarly, age-standardized rates of these indexes per 100,000 people and the proportion of total YLD caused by knee OA in each country and for the MENA region were evaluated. Results The prevalence of knee osteoarthritis in the MENA region increased 2.88-fold, from 6.16 million cases to 17.75 million, between 1990 and 2019. Furthermore, in 2019, knee osteoarthritis accounted for approximately 1.69 million (95% UI 1.46–1.95) incident cases in MENA. The age-standardized prevalence was higher in women between 1990 (3.94% [95% UI 3.39–4.55] in women and 3.24% [95% UI 2.79–3.72] in men) and 2019 (4.44% [95% UI 3.83–5.10] in women and 3.66% [3.14–4.21] in men). Total YLDs due to knee osteoarthritis increased by more than 2.88-fold, rising from 196.29 thousand [95% UI 97.17–399.29] in 1990 to 564.66 thousand [95% UI 275.06–1,150.68] in 2019. In the year 2019, Kuwait, Turkey, and Oman had the highest age-standardized prevalence (4.42% [95% UI 3.79–5.08]), YLD (132.41 [95% UI 65.79–267.56] per 100 000), and increase (21.17%) in YLD compared with 1990 in MENA region, respectively. Conclusion The prevalence of and YLDs due to knee OA in MENA has escalated over the last three decades. Considering the expanding burden of knee OA in MENA, policymakers should be more concerned to implement preventive strategies.
Introduction Total hip replacement (THR) is performed in an increasing number of individuals around the world and while improvements in pain reduction and long-term enhancement of muscle strength are well documented, the improvement in daily activity does not follow the same trend. This study aimed to determine the feasibility of a 5-week intervention where a personalised outdoor walking distance is monitored using a commercial activity monitor (Fitbit Charge 4). Method Data was collected on gait and activities of daily living using patient reported outcome measures. Following the completion of the intervention period, participants took part in a semi-structured interview to voice their opinion on the use of the activity monitor, their experiences, and any challenges in order to assess the feasibility of the intervention. All quantitative data were presented descriptively, using appropriate summary statistics. Interviews were analysed using thematic analysis. Results Five participants who had undergone total hip replacement surgery within the postoperative period of 3 to 6 months were recruited from the local community. Conclusion The findings suggest that the intervention was feasible and that it encouraged all participants to increase their daily activity. Therefore, it can be concluded that a follow-up effectiveness trial is warranted.
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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.
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.
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.
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.
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.
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 $1,127 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.
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 US$1008 and US$1200, 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.