Cost Savings are Good News as Aging Population Rapidly Increases Demand for Relief from Chronic Knee Pain
At the age of 46, elementary school teacher Linda Seward started noticing difficulty maintaining mobility and keeping up with her class due to constant knee pain. After years of pain medication and alternative treatments, Linda, like many other Americans who face osteoarthritis of the knee, didn’t see measurable improvements and was at the point where her quality of life and ability to work suffered.
“It got to a point where I couldn’t walk more than a few yards without pain and it was very difficult to stoop, bend, or kneel. I was literally hanging onto walls when I walked students down the hall,” said Linda, who ultimately underwent knee replacement surgery as a last resort at the age of 56. “Since my surgery, there’s not a day that goes by that I’m not amazed at how I’m able to move without pain. I never have to take pain medication and it’s like I’m in my thirties again.”
There is a desire among the aging population to stay active and remain in the workforce. The combination of the aging population and the rising epidemic of obesity can lead to an increasing demand for joint replacement.The demand for total knee replacement is expected to exceed 3 million by the year 2030 – up from 600,000 in 2009 – according to the Agency for Healthcare Research and Quality.
A new study published this month in the Journal of Bone and Joint Surgery (JBJS) demonstrates the importance of maintaining access to knee replacement surgery for those suffering from osteoarthritis.
Researchers found that the societal benefits for working-age knee replacement patients far outweigh the actual cost of the surgery and rehabilitation, compared to non-surgical treatments for osteoarthritis of the knee. The direct costs for knee replacement surgery and rehabilitation of a Medicare patient averaged $20,704 and these costs are offset by an average indirect savings of $39,697. The end result is a lifetime societal net benefit ranging from $10,000 - $30,000 per patient.
“Most of the societal savings come from the patient’s ability to maintain employment and increase earnings over a longer time in the workforce. “We also found benefits from fewer missed worked days and lower disability payments,” said study author and health care economist Lane Koenig, Ph.D. “This methodology application has opened the door for a broader set of health care services to be evaluated using a societal perspective, which is truly exciting.”
More than 90% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living, allowing them to return to work and tremendously enhance their quality of life . The new study, “The Direct and Indirect Costs to Society of Treatment for End-Stage Knee Osteoarthritis,” shows how knee replacement surgery can be a valuable and cost-effective treatment for patients with end-stage osteoarthritis, estimating lifetime societal savings of about $12 billion from the more than 600,000 total knee replacement surgeries performed in the U.S. in 2009.
“The demographic profile of a knee replacement patient is changing,” says John R. Tongue, MD, American Academy of Orthopaedic Surgeons (AAOS) past-president. “Half the patients getting knee replacements now are younger than 65 years of age and most of them are still in the workforce.”
Dr. Tongue adds, “We know that when a knee replacement is done on patients at the appropriate time, it adds tremendous value to their lives. It gets them back to work and back to their families. It improves their quality of life and allows them to be productive and active again. But until now, that value has been hard to quantify. This study allows patients to see the big picture effect on their daily lives and in the long term.
“These patients return to work and remain productive. This study confirms these societal benefits and adds support for such treatments as we begin to make cost-conscious health care decisions,” notes William J. Robb, MD, senior partner, Illinois Bone and Joint Institute and Senior Attending, Department of Orthopaedic Surgery, Northshore University HealthSystem.
To conduct the study, researchers reviewed literature and Medicare claims data. The collected data were applied to a Markov Decision Model which they used to estimate the total societal savings. This new methodological model, published this year in Cost Effectiveness and Resource Allocation, allowed researchers to calculate indirect economic and societal impacts for orthopaedic procedures. This methodology was then applied to the economic impact of total knee replacements.
The full JBJS study “The Direct and Indirect Costs to Society of Treatment for End-Stage Knee Osteoarthritis,” identifying a quantifiable view of the value of knee replacement surgery compares costs for direct medical care, long-term medical care, home modification and long-term nursing home use for both surgical and non-surgical treatments among patients age 65 and older. It is available at www.ANationInMotion.org/Value/Knee.
AAOS commissioned KNG Health Consulting, LLC and its partner, IHS Global Inc., to prepare this study.
JBJS, Inc., is a not-for-profit publisher specializing in orthopaedic information. It publishes the Journal of Bone & Joint Surgery, which has been the most valued source of information for orthopaedic surgeons and researchers for over 100 years and is the gold standard in peer-reviewed scientific information in the field – a core journal and essential reading for orthopaedic surgeons worldwide. Other publications include JBJS Case Connector and JBJS Essential Surgical Techniques.
A Nation in Motion
More than one in four Americans have bone or joint health problems, making them the greatest cause of lost work days in the U.S. When orthopaedic surgeons (www.aaos.org) restore mobility and reduce pain, they help people get back to work and to independent, productive lives. Orthopaedic surgeons provide a great value in American medicine in both human and economic terms and access to high-quality orthopaedic care keeps this “Nation in Motion.” To learn more, to read hundreds of patient stories or to submit your own story, visit www.ANationInMotion.org.