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Hardenberg M, Speklé EM, Coenen P, Brus IM, Kuijer PPFM. The economic burden of knee and hip osteoarthritis: absenteeism and costs in the Dutch workforce. BMC Musculoskelet Disord 2022; 23:364. [PMID: 35436874 PMCID: PMC9017043 DOI: 10.1186/s12891-022-05306-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to quantify the absenteeism costs of knee and hip osteoarthritis in the Netherlands for the Dutch workforce and specific groups of workers. Methods We used a longitudinal, dynamic database from a large occupational health service in which occupational physicians register information about personal information and sick leave of workers with the diagnosis of knee- and/or hip osteoarthritis. We included all employees aged 15 to 75 years performing paid work and diagnosed with knee and/or hip osteoarthritis. Costs were calculated annually and per episode for different subgroups from an employer’s perspective using the Human Capital Approach. In the Netherlands, the employer has to pay 70% of the employee's wage out of pocket for the first two years of sick leave and also for the occupational health care. In this way, employers receive information about the costs of workers on sick leave due to knee or hip osteoarthritis. This might stimulate investments in targeted prevention and work-directed care. Results For the period 2015–2017, 1399 workers fulfilled the inclusion criteria. An average sick leave episode of knee osteoarthritis had a duration of 186 calendar days and was associated with €15,550 in costs. For hip osteoarthritis these data were 159 calendar days and €12,482 in costs. These costs are particularly high among male workers and workers with a higher number of weekly working hours. The average annual costs for the Dutch workforce due to sick leave for knee and hip osteoarthritis were €26.9 million and €13.8 million, respectively. Sick leave costs decreased for hip and not for knee osteoarthritis during 2015–2017. Conclusions Annual sick leave costs due to knee and hip osteoarthritis are about €40 million for the Dutch workforce and approximately twice as high for knee compared to hip osteoarthritis. Average costs per sick leave episode are particularly high among male workers and workers with a higher number of weekly working hours. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05306-9.
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Affiliation(s)
- Marrit Hardenberg
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Erwin M Speklé
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Arbo Unie, Occupational Health Service, Utrecht, The Netherlands
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Iris M Brus
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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2
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Martins R, Kotsopoulos N, Kosaner Kließ M, Beck C, Abraham L, Large S, Schepman P, Connolly MP. Comparing the Fiscal Consequences of Controlled and Uncontrolled Osteoarthritis Pain Applying a UK Public Economic Perspective. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2021; 8:127-136. [PMID: 34239946 PMCID: PMC8238511 DOI: 10.36469/001c.24629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/21/2021] [Indexed: 05/12/2023]
Abstract
Background: Individuals experiencing osteoarthritis (OA) pain can pose significant costs for governments due to reduced work activity in these individuals and increasing reliance on public support benefits. In this analysis we capture the broader economic impact of OA pain by applying a government perspective, public economic framework to assess controlled and uncontrolled pain. Methods: We used a Markov model to compare labour market participation in people with uncontrolled OA hip or knee pain compared to a cohort with controlled OA pain. The likelihood of employment, long-term sickness, disability, and early retirement in those with controlled pain used publicly available UK data. The relative effect of uncontrolled OA pain on fiscal outcomes is drawn from peer reviewed publications reporting reduced work activity and reliance on public benefits for people with uncontrolled OA pain. Lost tax revenue was derived using UK tax rates and national insurance contributions applied to annual earnings. Social benefit rules were applied to calculate government financial support to individuals. Health-care costs were calculated based on estimates from an UK observational study. The base case analysis compared the projected lost tax revenue and transfer payments for a 50-year-old cohort with severe OA pain, retiring at age 65. Results: For a 50-year-old individual with moderate uncontrolled OA pain with 15-years remaining work expectancy, the model estimated a £62 383 reduction in employment earnings, a £24 307 reduction in tax contributions and a need for £16 034 in government benefits, compared to a person with controlled OA pain. In people with severe uncontrolled OA pain incremental foregone earnings were estimated to be £126 384, £44 925 were not paid through taxation and £25 829 were received in public benefits, compared to the controlled pain cohort. Health-care costs represented 13% and 12% of all OA-related fiscal cost in the moderate uncontrolled OA pain and severe uncontrolled OA pain comparison, respectively. Conclusions: For governments, maintaining an active workforce is paramount to maintaining economic growth and reducing spending on government programs. The approach described here can be used to augment cost-effectiveness models to inform a range of stakeholders of benefits attributed to controlled OA pain.
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Affiliation(s)
- Rui Martins
- Health Economics, Global Market Access Solutions
| | - Nikos Kotsopoulos
- Health Economics, Global Market Access Solutions; Economics, University of Athens
| | | | | | | | | | | | - Mark P Connolly
- Health Economics, Global Market Access Solutions; Pharmacoeconomics, University of Groningen
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3
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Demiralp B, Koenig L, Nguyen JT, Soltoff SA. Determinants of Hip and Knee Replacement: The Role of Social Support and Family Dynamics. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019837438. [PMID: 30947603 PMCID: PMC6452775 DOI: 10.1177/0046958019837438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The objective of this study was to examine variations in the determinants of joint replacement (JR) across gender and age, with emphasis on the role of social support and family dynamics. We analyzed data from the US Health and Retirement Study (1998-2010) on individuals aged 45 or older with no prior receipt of JR. We used logistic regression to analyze the probability of receiving knee or hip replacement by gender and age (<65, 65+). We estimated the effect of demographic, health needs, economic, and familial support variables on the rate of JR. We found that being married/partnered with a healthy spouse/partner is positively associated with JR utilization in both age groups (65+ group OR: 1.327 and <65 group OR: 1.476). While this finding holds for men, it is not statistically significant for women. Among women younger than 65, having children younger than 18 lowers the odds (OR: 0.201) and caring for grandchildren increases the odds (1.364) of having a JR. Finally, elderly women who report availability of household assistance from a child have higher odds of receiving a JR as compared with elderly women without a child who could assist (OR: 1.297). No effect of available support from children was observed for those below 65 years old and elderly men. Our results show that intrafamily dynamics and familial support are important determinants of JR; however, their effects vary by gender and age. Establishing appropriate support mechanisms could increase access to cost-effective JR among patients in need of surgery.
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Affiliation(s)
| | - Lane Koenig
- 1 KNG Health Consulting, LLC, Rockville, MD, USA
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4
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Thewlis D, Bahl JS, Fraysse F, Curness K, Arnold JB, Taylor M, Callary S, Solomon LB. Objectively measured 24-hour activity profiles before and after total hip arthroplasty. Bone Joint J 2019; 101-B:415-425. [PMID: 30929490 DOI: 10.1302/0301-620x.101b4.bjj-2018-1240.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this exploratory study was to investigate if the 24-hour activity profile (i.e. waking activities and sleep) objectively measured using wrist-worn accelerometry of patients scheduled for total hip arthroplasty (THA) improves postoperatively. PATIENTS AND METHODS A total of 51 THA patients with a mean age of 64 years (24 to 87) were recruited from a single public hospital. All patients underwent THA using the same surgical approach with the same prosthesis type. The 24-hour activity profiles were captured using wrist-worn accelerometers preoperatively and at 2, 6, 12, and 26 weeks postoperatively. Patient-reported outcomes (Hip Disability and Osteoarthritis Outcome Score (HOOS)) were collected at all timepoints except two weeks postoperatively. Accelerometry data were used to quantify the intensity (sedentary, light, moderate, and vigorous activities) and frequency (bouts) of activity during the day and sleep efficiency. The analysis investigated changes with time and differences between Charnley class. RESULTS Patients slept or were sedentary for a mean of 19.5 hours/day preoperatively and the 24-hour activity pattern did not improve significantly postoperatively. Outside of sleep, the patients spent their time in sedentary activities for a mean of 620 minutes/day (sd 143) preoperatively and 641 minutes/day (sd 133) six months postoperatively. No significant improvements were observed for light, moderate, and vigorous intensity activities (p = 0.140, p = 0.531, and p = 0.407, respectively). Sleep efficiency was poor (< 85%) at all timepoints. There was no postoperative improvement in sleep efficiency when adjusted for medications (p > 0.05). Patient-reported outcome measures showed a significant improvement with time in all domains when compared with preoperative levels. There were no differences with Charnley class at six months postoperatively. However, Charnley class C patients were more sedentary at two weeks postoperatively when compared with Charnley class A patients (p < 0.05). There were no further differences between Charnley classifications. CONCLUSION This study describes the 24-hour activity profile of THA patients for the first time. Prior to THA, patients in this cohort were inactive and slept poorly. This cohort shows no improvement in 24-hour activity profiles at six months postoperative. Cite this article: Bone Joint J 2019;101-B:415-425.
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Affiliation(s)
- D Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - J S Bahl
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - F Fraysse
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - K Curness
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - J B Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - M Taylor
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, Australia
| | - S Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - L B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
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Malizos KN. Global Forum: The Burden of Bone and Joint Infections: A Growing Demand for More Resources. J Bone Joint Surg Am 2017; 99:e20. [PMID: 28244919 DOI: 10.2106/jbjs.16.00240] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The rate and severity of septic complications following joint replacement surgery and the incidence of posttraumatic infections are projected to increase at a faster pace because of a tendency to operate on high-risk patients, including older patients, patients with diabetes, and patients who are immunocompromised or have comorbidities. Musculoskeletal infections are devastating adverse events that may become life-threatening conditions. They create an additional burden on total health-care expenditures, and can lead to functional impairment, long-lasting disability, or even permanent handicap, with the inevitable social and economic burdens. The scientific community should take a more active role to draw public attention to the plight of hundreds of thousands of people across the globe who experience complications, become disabled, and, in some cases, die, and it should highlight what could be achieved if the global community takes decisive steps to improve access, early detection, and appropriate care. However, mitigating the adverse personal, clinical, and socioeconomic effects of these conditions requires increasing financial resources provided by both governments and funding organizations. Furthermore, a targeted action plan from the providers and the professional societies should be put in place so that the burden created by bone and joint infections is included in the agenda for global health-care priorities.
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Affiliation(s)
- Konstantinos N Malizos
- 1Department of Orthopaedic Surgery & Musculoskeletal Trauma, Medical School, University of Thessaly, Biopolis Larissa, Greece
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Lo T, Parkinson L, Cunich M, Byles J. Discordance between self-reported arthritis and musculoskeletal signs and symptoms in older women. BMC Musculoskelet Disord 2016; 17:494. [PMID: 27905906 PMCID: PMC5133957 DOI: 10.1186/s12891-016-1349-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/23/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Arthritis is a gendered disease where women have a higher prevalence and more disability than men with arthritis of the same age. Health survey data is a major source of information for monitoring of the burden of arthritis. The validity of self-reported arthritis and the determinants of its accuracy among women have not been thoroughly studied. The objectives of this study were to: 1) examine the agreement between self-report diagnosed arthritis and musculoskeletal signs and symptoms in community-living older women; 2) estimate the sensitivity, specificity, and predictive values of self-reported arthritis; and 3) assess the factors associated with the disagreement. METHODS A cross-sectional survey of women was undertaken in 2012-13. The health survey asked women about diagnosed arthritis and musculoskeletal signs and symptoms. Agreement between self-reported arthritis and musculoskeletal signs symptoms was measured by Cohen's kappa. Sensitivity, specificity, and predictive values of self-reported arthritis were estimated using musculoskeletal signs and symptoms as the reference standard. Factors associated with disagreement between self-reported arthritis and the reference standard were examined using multiple logistic regression. RESULTS There were 223 participants self-reported arthritis and 347 did not. A greater number of participants who self-reported arthritis were obese compared to those who did not report arthritis. Those who reported arthritis had worse health, physical functioning, and arthritis symptom measures. Among the 570 participants, 198 had musculoskeletal signs and symptoms suggesting arthritis (the reference standard). Agreement between self-reported arthritis and the reference standard was moderate (kappa = 0.41). Sensitivity, specificity, and positive and negative predictive values of self-reported arthritis in older women were 66.7, 75.5, 59.2, and 81.0% respectively. Regression analysis results indicated that false-positive is associated with better health measured by the Short Form 36 physical summary score, the Health Assessment Questionnaire disability index, or the Western Ontario and McMaster University Osteoarthritis Index total score; whereas false-negative is negatively associated with these variables. CONCLUSION While some women who reported diagnosed arthritis did not have recent musculoskeletal signs or symptoms, others with the signs and symptoms did not report diagnosed arthritis. Researchers should use caution when employing self-reported arthritis as the case-definition in epidemiological studies.
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Affiliation(s)
- Tkt Lo
- Research Centre for Gender, Health and Ageing, HMRI, University of Newcastle, C/- University Drive, Callaghan, NSW, 2308, Australia.
| | - Lynne Parkinson
- Central Queensland University, Rockhampton, QLD, 4701, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Michelle Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, 2006, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Julie Byles
- Research Centre for Gender, Health and Ageing, HMRI, University of Newcastle, C/- University Drive, Callaghan, NSW, 2308, Australia
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7
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Aigner R, Meier Fedeler T, Eschbach D, Hack J, Bliemel C, Ruchholtz S, Bücking B. Patient factors associated with increased acute care costs of hip fractures: a detailed analysis of 402 patients. Arch Osteoporos 2016; 11:38. [PMID: 27815914 DOI: 10.1007/s11657-016-0291-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/25/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of the present study was to identify patient factors associated with higher costs in hip fracture patients. The mean costs of a prospectively observed sample of 402 patients were 8853 €. The ASA score, Charlson comorbidity index, and fracture location were associated with increased costs. PURPOSE Fractures of the proximal end of the femur (hip fractures) are of increasing incidence due to demographic changes. Relevant co-morbidities often present in these patients cause high complication rates and prolonged hospital stays, thus leading to high costs of acute care. The aim of this study was to perform a precise cost analysis of the actual hospital costs of hip fractures and to identify patient factors associated with increased costs. METHODS The basis of this analysis was a prospectively observed single-center trial, which included 402 patients with fractures of the proximal end of the femur. All potential cost factors were recorded as accurately as possible for each of the 402 patients individually, and statistical analysis was performed to identify associations between pre-existing patient factors and acute care costs. RESULTS The mean total acute care costs per patient were 8853 ± 5676 € with ward costs (5828 ± 4294 €) and costs for surgical treatment (1972 ± 956 €) representing the major cost factors. The ASA score, Charlson comorbidity index, and fracture location were identified as influencing the costs of acute care for hip fracture treatment. CONCLUSION Hip fractures are associated with high acute care costs. This study underlines the necessity of sophisticated risk-adjusted payment models based on specific patient factors. Economic aspects should be an integral part of future hip fracture research due to limited health care resources.
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Affiliation(s)
- R Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany.
| | - T Meier Fedeler
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - D Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - J Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - C Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - S Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - B Bücking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Baldingerstraße, D-35043, Marburg, Germany
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8
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Salmon JH, Rat AC, Sellam J, Michel M, Eschard JP, Guillemin F, Jolly D, Fautrel B. Economic impact of lower-limb osteoarthritis worldwide: a systematic review of cost-of-illness studies. Osteoarthritis Cartilage 2016; 24:1500-8. [PMID: 27034093 DOI: 10.1016/j.joca.2016.03.012] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/18/2016] [Accepted: 03/13/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE An overview of the economic consequences - overall costs as well as cost breakdown (direct and indirect) - of hip and knee osteoarthritis (OA) worldwide. METHODS A systematic literature search of EMBASE, MEDLINE, Scopus and Cochrane databases for articles was performed independently by two rheumatologists who used the same predefined eligible criteria. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were converted to an annual cost and to 2013 euros (€) by using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average. RESULTS A total of 45 abstracts were selected, and 32 articles were considered for the review. The studied populations were heterogeneous: administrative, hospital and national health survey data. Annual total costs per patient ranged from 0.7 to 12 k€, direct costs per patient from 0.5 to 10.9 k€ and indirect costs per patient from 0.2 to 12.3 k€. The weighted average annual costs per patient living with knee and hip OA were 11.1, 9.5 and 4.4 k€ for total, direct and indirect costs, respectively. CONCLUSIONS This review highlights the heterogeneity of studies and lack of methodologic consensus to obtain reliable cost-of-illness estimates for lower-limb OA. However, costs induced by the disease seem substantial and deserve to be more extensively explored.
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Affiliation(s)
- J H Salmon
- Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, F-51092, France; University of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, Reims, F-51095, France.
| | - A C Rat
- Rheumatology Department, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France; Université de Lorraine, Université Paris Descartes, Apemac, EA4360, 54000, Nancy, France; INSERM, CIC-EC 1433, 54000, Nancy, France.
| | - J Sellam
- Rheumatology Department, Saint-Antoine Hospital, Inserm UMR S_938, Sorbonne Universités UPMC Univ Paris 06, Assistance Publique - Hôpitaux de Paris (AP-HP), DHU i2B, Paris, France.
| | - M Michel
- Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, F-51092, France.
| | - J P Eschard
- Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, F-51092, France.
| | - F Guillemin
- Université de Lorraine, Université Paris Descartes, Apemac, EA4360, 54000, Nancy, France; INSERM, CIC-EC 1433, 54000, Nancy, France.
| | - D Jolly
- University of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, Reims, F-51095, France; Department of Research and Innovation, Robert Debré Hospital, Reims University Hospitals, Reims, F-51092, France.
| | - B Fautrel
- Rheumatology Department, Université Pierre et Marie Curie Curie - Paris 6, GRC08, Institut Pierre Louis de d'Epidémiologie et Santé Publique, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
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9
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Gwynne-Jones DP, Iosua EE, Stout KM. Rationing for Total Hip and Knee Arthroplasty Using the New Zealand Orthopaedic Association Score: Effectiveness and Comparison With Patient-Reported Scores. J Arthroplasty 2016; 31:957-62. [PMID: 26944014 DOI: 10.1016/j.arth.2015.11.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/15/2015] [Accepted: 11/18/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is increasing interest in scoring systems to prioritize patients for hip and knee arthroplasty. The purpose of this study was to determine the effectiveness of the New Zealand Orthopaedic Association (NZOA) score and compare it with patient-reported scores of patients listed for hip and knee arthroplasty. METHODS Over a 1-year period, all patients listed for primary hip and knee arthroplasty were scored by a prioritization nurse. The NZOA score, outcome, preoperative Oxford hip or knee score (OHKS) and reduced Western Ontario McMaster osteoarthritis index (WOMAC) score (RWS) were collected. RESULTS Overall, 608 patients were listed for hip (319) or knee (289) arthroplasty. The mean scores for knees were all better than hips (P < .001). On initial scoring, 324 patients (53%) were given certainty (mean NZOA, 80.5; OHKS, 10.0; RWS, 35.1), 90 (15%) given clinical over-ride (NZOA, 69.6; OHKS, 12.0; RWS, 33.2), and 194 (32%) returned to general practitioner (NZOA, 64; OHKS, 14.2; RWS, 30.8). Knees (38%) were more likely to be returned than hips (26%; P = .002). Fifty (26%) were re-referred during the study period (mean, 5 months) and given certainty or over-ride. The difference at final outcome between patients with certainty and clinical over-ride was NZOA, 10.3 points; Oxford, 1.6 points; and RWS, 1.4 points. The difference between clinical over-ride and returned to general practitioner was NZOA, 7.2; Oxford, 4.4; RWS, 5.3. CONCLUSION The NZOA score is an effective tool for rationing for joint arthroplasty. Patients around the threshold score of 70 may not have a clinically important difference compared with those above threshold.
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Affiliation(s)
- David P Gwynne-Jones
- Department of Orthopaedic Surgery, Dunedin Hospital, Southern DHB, Dunedin, New Zealand; Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ella E Iosua
- Department of Social and Preventive Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kirsten M Stout
- Department of Orthopaedic Surgery, Dunedin Hospital, Southern DHB, Dunedin, New Zealand
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10
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Kasch R, Assmann G, Merk S, Barz T, Melloh M, Hofer A, Merk H, Flessa S. Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department? BMC Musculoskelet Disord 2016; 17:112. [PMID: 26932453 PMCID: PMC4774180 DOI: 10.1186/s12891-016-0962-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/23/2016] [Indexed: 02/02/2023] Open
Abstract
Background The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Methods Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department’s point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. Results The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p < .001 and p = 0.019) for ex- and implantation (€4147 vs. €6680 and €429 vs. €306) while length of stay and reimbursement were comparable. Conclusions This is the first detailed analysis of the hospital department’s cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.
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Affiliation(s)
- R Kasch
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany.
| | - G Assmann
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany.,Department of Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - S Merk
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - T Barz
- Department of Orthopedics and Trauma Surgery, Asklepios Hospital Uckermark, Schwedt, Germany
| | - M Melloh
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany.,Center for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - A Hofer
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - H Merk
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - S Flessa
- Department of Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University, Greifswald, Germany
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11
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Hansen VJ, Gromov K, Lebrun LM, Rubash HE, Malchau H, Freiberg AA. Does the Risk Assessment and Prediction Tool predict discharge disposition after joint replacement? Clin Orthop Relat Res 2015; 473:597-601. [PMID: 25106801 PMCID: PMC4294888 DOI: 10.1007/s11999-014-3851-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Payers of health services and policymakers place a major focus on cost containment in health care. Studies have shown that early planning of discharge is essential in reducing length of stay and achieving financial benefit; tools that can help predict discharge disposition would therefore be of use. The Risk Assessment and Prediction Tool (RAPT) is a preoperative survey constructed to predict discharge disposition after total joint arthroplasty (TJA). The RAPT was developed and tested on a population of Australian patients undergoing joint replacement, but its validity in other populations is unknown. A low RAPT score is reported to indicate a high risk of needing any form of inpatient rehabilitation after TJA, including short-term nursing facilities. QUESTIONS/PURPOSES This study attempts (1) to assess predictive accuracy of the RAPT on US patients undergoing total hip and knee arthroplasty (THA/TKA); and (2) to determine predictive accuracy of each individual score (1-12). METHODS Between June 2006 and December 2011, RAPT scores of 3213 patients (1449 THAs; 1764 TKAs) were prospectively captured during the preoperative clinical visit. Scores were stored along with other clinical data, including discharge disposition, in a dedicated database on a secure server. The database was queried by the nursing case manager to retrieve the RAPT scores of all patients captured during this time period. Binary logistic regression was used to analyze the scores and determine predictive accuracy. RESULTS Overall predictive accuracy was 78%. RAPT scores<6 and >10 (of 12) predicted with >90% accuracy discharge to inpatient rehabilitation and home, respectively. Predictive accuracy was lowest for scores between 7 and 10 at 65.2% and almost 50% of patients received scores in this range. Based on our findings, the risk categories in our populations should be high risk<7, intermediate risk 7 to 10, and low risk>10. CONCLUSIONS The RAPT accurately predicted discharge disposition for high- and low-risk patients in our cohort. Based on our data, intermediate-risk patients should be defined as those with scores of 7 to 10. Predictive accuracy for these patients could potentially be improved through the identification and addition of other factors correlated to discharge disposition. The RAPT allows for identification of patients who are likely to be discharged home or to rehabilitation, which may facilitate preoperative planning of postoperative care. Additionally, it identifies intermediate-risk patients and could be used to implement targeted interventions to facilitate discharge home in this group of patients. LEVEL OF EVIDENCE Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Viktor J. Hansen
- />Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA USA
| | - Kirill Gromov
- />Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA USA
- />Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Lauren M. Lebrun
- />Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 3B, Boston, MA 02114 USA
| | - Harry E. Rubash
- />Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 3B, Boston, MA 02114 USA
| | - Henrik Malchau
- />Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA USA
- />Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 3B, Boston, MA 02114 USA
| | - Andrew A. Freiberg
- />Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 3B, Boston, MA 02114 USA
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12
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Reducing hospital length of stay following total hip and knee replacement surgery with a dedicated fast track program. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Comparative study of the femoroacetabular impingement (FAI) prevalence in male semiprofessional and amateur soccer players. Arch Orthop Trauma Surg 2014; 134:1135-41. [PMID: 24858466 DOI: 10.1007/s00402-014-2008-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) represents a novel approach to the mechanical etiology of hip osteoarthritis. The cam-type femoroacetabular impingement deformity occurs frequently in young male athletes. The aim of our study was to evaluate the prevalence of FAI in male semiprofessional soccer players using clinical examination and magnetic resonance imaging (MRI), compared to amateur soccer players. In MRI, the α angle of Nötzli is determined for quantifying FAI. MATERIALS AND METHODS According to power analysis, a total of 22 asymptomatic semiprofessional soccer players with a median of 23.3 years of age (range 18-30 years) and 22 male amateur soccer players with a median of 22.5 years of age (control group, range 18-29 years) underwent an MRI to measure the hip α angle of Nötzli. The α angle of the kicking legs of the semiprofessional group and the amateur group were analyzed. The study group was moreover evaluated by the Hip Outcome Score (HOS) and a clinical hip examination including range of motion (ROM) and impingement tests. RESULTS In the semiprofessional group, 19 soccer players had a right kicking leg and 1 soccer player had a left kicking leg. 2 soccer players kicked with two feet. In the semi-professional group, the mean value of the α angle of the kicking leg (57.3 ± 8.2°) was significantly higher than in the amateur group (51.7 ± 4.8°, P = 0.008). In the semi-professional group, 15 (62.5 %) of 24 kicking legs had an increased α angle >55°, while 5 (27.3 %) kicking legs of the amateur group had an α angle >55°. Five semi professional soccer players had findings in clinical examination, whereof 4 had an increased α angle >55°. No participant of the amateur group showed pathological results in the clinical examination (P = 0.0484). Overall, semiprofessional soccer players had a higher proportion of an increased α angle than the amateur group. CONCLUSIONS Semiprofessional players have a higher prevalence of an increased α angle in the kicking leg than the amateur group at the same age. The kicking leg is predisposed for FAI.
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14
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Lindgren JV, Wretenberg P, Kärrholm J, Garellick G, Rolfson O. Patient-reported outcome is influenced by surgical approach in total hip replacement. Bone Joint J 2014; 96-B:590-6. [DOI: 10.1302/0301-620x.96b5.32341] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The effects of surgical approach in total hip replacement on health-related quality of life and long-term pain and satisfaction are unknown. From the Swedish Hip Arthroplasty Register, we extracted data on all patients that had received a total hip replacement for osteoarthritis through either the posterior or the direct lateral approach, with complete pre- and one-year post-operative Patient Reported Outcome Measures (PROMs). A total of 42 233 patients met the inclusion criteria and of these 4962 also had complete six-year PROM data. The posterior approach resulted in an increased mean satisfaction score of 15 (sd 19) vs 18 (sd 22) (p < 0.001) compared with the direct lateral approach. The mean pain score was 13 (sd 17) vs 15 (sd 19) (p < 0.001) and the proportion of patients with no or minimal pain was 78% vs 74% (p < 0.001) favouring the posterior approach. The patients in the posterior approach group reported a superior mean EQ-5D index of 0.79 (sd 0.23) vs 0.77 (sd 0.24) (p < 0.001) and mean EQ score of 76 (sd 20) vs 75 (sd 20) (p < 0.001). All observed differences between the groups persisted after six years follow-up. Although PROMs after THR in general are very good regardless of surgical approach, the results indicate that some patients operated by the direct lateral approach report an inferior outcome compared with the posterior approach. The large number of procedures and the seemingly sustained differences make it likely these findings are clinically relevant. Cite this article: Bone Joint J 2014;96-B:590–6.
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Affiliation(s)
- J. V. Lindgren
- Karolinska Institutet, Department
of Molecular Medicine and Surgery, Section
of Orthopaedics, SE-171 77 Stockholm, Sweden
and the Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - P. Wretenberg
- Karolinska Institutet, Department
of Molecular Medicine and Surgery, Section
of Orthopaedics, SE-171 77 Stockholm, Sweden
| | - J. Kärrholm
- Institute of Clinical Sciences, Department
of Orthopaedics, The Sahlgrenska Academy, University
of Gothenburg,
SE-413 45 Gothenburg, Sweden and Swedish Hip
Arthroplasty Register, Gothenburg, Sweden
| | - G. Garellick
- Institute of Clinical Sciences, Department
of Orthopaedics, The Sahlgrenska Academy, University
of Gothenburg,
SE-413 45 Gothenburg, Sweden and Swedish Hip
Arthroplasty Register, Gothenburg, Sweden
| | - O. Rolfson
- Institute of Clinical Sciences, Department
of Orthopaedics, The Sahlgrenska Academy, University
of Gothenburg,
SE-413 45 Gothenburg, Sweden and Swedish Hip
Arthroplasty Register, Gothenburg, Sweden
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15
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Fyie K, Frank C, Noseworthy T, Christiansen T, Marshall DA. Evaluating the primary-to-specialist referral system for elective hip and knee arthroplasty. J Eval Clin Pract 2014; 20:66-73. [PMID: 24004242 DOI: 10.1111/jep.12080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 12/31/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Persistently long waiting times for hip and knee total joint arthroplasty (TJA) specialist consultations have been identified as a problem. This study described referral processes and practices, and their impact on the waiting time from referral to consultation for TJA. METHODS A mixed-methods retrospective study incorporating semi-structured interviews, patient chart reviews and observational studies was conducted at three clinic sites in Alberta, Canada. A total of 218 charts were selected for analysis. Standardized definitions were applied to key event dates. Performance measures included waiting times percentage of referrals initially accepted. Voluntary (patient-related) and involuntary (health system-related) waiting times were quantified. RESULTS All three clinics had defined, but differing, referral processing rules. The mean time from referral to consultation ranged from 51 to 139 business days. Choosing a specific surgeon for consultation rather than a next available surgeon lengthened waits by 10-47 business days. Involuntary waiting times accounted for at least 11% of total waiting time. Approximately 40-80% of the time patients with TJA wait for surgery was in the consultation period. Fifty-four per cent of new referrals were initially rejected, prolonging patient waits by 8-46 business days. CONCLUSIONS Our results suggest that variation in referral processing led to increased waiting times for patients. The large proportion of total wait attributable to waiting for a surgical consultation makes failure to measure and evaluate this period a significant omission. Improving referral processes and decreasing variation between clinics would improve patient access to these specialist referrals in Alberta.
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Affiliation(s)
- Ken Fyie
- Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Alberta, Canada
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