A Population-Based Nested Case-Control Study of the Costs of Hip and Knee Replacement Surgery
Background: Studies of total joint arthroplasty (TJA) have not evaluated the costs and outcomes in the context of expected arthritis worsening. Objectives: Using a cost-consequence approach, to examine changes in direct health care costs and arthritis severity after TJA for hip/knee arthritis compar...
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Veröffentlicht in: | Medical care 2009-07, Vol.47 (7), p.732-741 |
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description | Background: Studies of total joint arthroplasty (TJA) have not evaluated the costs and outcomes in the context of expected arthritis worsening. Objectives: Using a cost-consequence approach, to examine changes in direct health care costs and arthritis severity after TJA for hip/knee arthritis compared with contemporaneous changes in matched controls. Research Design: Case control study nested in a population-based prospective cohort. Subjects: In a population cohort with disabling hip/knee osteoarthritis followed from 1996 to 2003, primary TJA recipients were matched with cohort nonrecipients on age, sex, region of residence, comorbidity, and inflammatory arthritis diagnosis. Measures: Pre-and postoperative total and arthritis-attributable direct health care costs, arthritis severity, and general health status were compared for cases and matched controls. Results: Of 2109 participants with no prebaseline TJA, 185 cases received a single elective TJA during the follow-up period; of these, 183 cases and controls were successfully matched. Mean age was 71 years, 77.6% were female, 35.5% had ≥ 2 comorbidities, and 81.5% had ≥ 2 joints affected. At baseline, controls had less pain and disability and lower total and arthritis-attributable health care costs than cases. After surgery, although overall health care utilization was unchanged, cases experienced significant decreases in arthritis- attributable costs (mean decrease $278 including prescription drugs) and pain and disability (P < 0.0001 for all). Over the same time period, controls experienced a significant increase in total health care costs (mean increase $1978 including prescription drugs, P = 0.04) and no change or worsening of their arthritis status. Conclusion: Compared with matched controls, arthroplasty is associated with significant reductions in pain, disability, and arthritisattributable direct costs. |
doi_str_mv | 10.1097/MLR.0b013e3181934553 |
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fullrecord | <record><control><sourceid>jstor_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_67415010</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>40221947</jstor_id><sourcerecordid>40221947</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4033-99490693f13dd17f788143eea567ca4282f4b09f8ccb749ff67a2de3f09cd3833</originalsourceid><addsrcrecordid>eNqFkUtv1DAUhS0EotPCPwBksegu5foVx8s2AooYHmphiSxPcs3MkImD7aiaf4-rGYHUDaujI33n6OpcQl4wuGBg9JtPy5sLWAETKFjDjJBKiUdkwZTQFTOyeUwWAFxVGrQ5IacpbQGYFoo_JSfMKFGDkAvy45J-DdM8uLwJY3XlEvb0M6ZcpC2masOYYxjobZ77PQ2e5jXSNqSc7s31ZqJu7OnHEZHe4DS4Dnc4Zno7x58Y98_IE--GhM-Peka-v3v7rb2ull_ef2gvl1UnQYjKGGmgNsIz0fdMe900TApEp2rdOckb7uUKjG-6bqWl8b7WjvcoPJiuF40QZ-T80DvF8Hsu59vdJnU4DG7EMCdba8kUMCjg6wfgNsxxLLdZDloqDooVSB6gLoaUIno7xc3Oxb1lYO-3t2V7-3D7Ent17J5XO-z_hY5jF6A5AHdhyBjTr2G-w2jX6Ia8_l_3y0N0m3KIf6slcF5-rcUfwmSZXQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>207452051</pqid></control><display><type>article</type><title>A Population-Based Nested Case-Control Study of the Costs of Hip and Knee Replacement Surgery</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><source>JSTOR Archive Collection A-Z Listing</source><creator>Hawker, Gillian A. ; Badley, Elizabeth M. ; Croxford, Ruth ; Coyte, Peter C. ; Glazier, Richard H. ; Guan, Jun ; Harvey, Bart J. ; Williams, J. I. ; Wright, James G.</creator><creatorcontrib>Hawker, Gillian A. ; Badley, Elizabeth M. ; Croxford, Ruth ; Coyte, Peter C. ; Glazier, Richard H. ; Guan, Jun ; Harvey, Bart J. ; Williams, J. I. ; Wright, James G.</creatorcontrib><description>Background: Studies of total joint arthroplasty (TJA) have not evaluated the costs and outcomes in the context of expected arthritis worsening. Objectives: Using a cost-consequence approach, to examine changes in direct health care costs and arthritis severity after TJA for hip/knee arthritis compared with contemporaneous changes in matched controls. Research Design: Case control study nested in a population-based prospective cohort. Subjects: In a population cohort with disabling hip/knee osteoarthritis followed from 1996 to 2003, primary TJA recipients were matched with cohort nonrecipients on age, sex, region of residence, comorbidity, and inflammatory arthritis diagnosis. Measures: Pre-and postoperative total and arthritis-attributable direct health care costs, arthritis severity, and general health status were compared for cases and matched controls. Results: Of 2109 participants with no prebaseline TJA, 185 cases received a single elective TJA during the follow-up period; of these, 183 cases and controls were successfully matched. Mean age was 71 years, 77.6% were female, 35.5% had ≥ 2 comorbidities, and 81.5% had ≥ 2 joints affected. At baseline, controls had less pain and disability and lower total and arthritis-attributable health care costs than cases. After surgery, although overall health care utilization was unchanged, cases experienced significant decreases in arthritis- attributable costs (mean decrease $278 including prescription drugs) and pain and disability (P < 0.0001 for all). Over the same time period, controls experienced a significant increase in total health care costs (mean increase $1978 including prescription drugs, P = 0.04) and no change or worsening of their arthritis status. Conclusion: Compared with matched controls, arthroplasty is associated with significant reductions in pain, disability, and arthritisattributable direct costs.</description><identifier>ISSN: 0025-7079</identifier><identifier>EISSN: 1537-1948</identifier><identifier>DOI: 10.1097/MLR.0b013e3181934553</identifier><identifier>PMID: 19536034</identifier><identifier>CODEN: MELAAD</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Hip - economics ; Arthroplasty, Replacement, Knee - economics ; Case-Control Studies ; Community Health Planning ; Comparative analysis ; Cost control ; Cost of Illness ; Cost-Benefit Analysis ; Disabilities ; Disabled Persons - rehabilitation ; Disabled Persons - statistics & numerical data ; Female ; Health care costs ; Health Care Costs - statistics & numerical data ; Health care expenditures ; Health Services Research ; Health Status ; Humans ; Joint replacement surgery ; Knees ; Male ; National Health Programs - economics ; National Health Programs - utilization ; Ontario - epidemiology ; Osteoarthritis, Hip - complications ; Osteoarthritis, Hip - economics ; Osteoarthritis, Hip - epidemiology ; Osteoarthritis, Hip - surgery ; Osteoarthritis, Knee - complications ; Osteoarthritis, Knee - economics ; Osteoarthritis, Knee - epidemiology ; Osteoarthritis, Knee - surgery ; Pain - etiology ; Pain - prevention & control ; Physicians ; Prescription drugs ; Prospective Studies ; Replacement value ; Studies ; Treatment Outcome</subject><ispartof>Medical care, 2009-07, Vol.47 (7), p.732-741</ispartof><rights>Copyright 2009 Lippincott Williams & Wilkins</rights><rights>2009 Lippincott Williams & Wilkins, Inc.</rights><rights>Copyright Lippincott Williams & Wilkins Jul 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4033-99490693f13dd17f788143eea567ca4282f4b09f8ccb749ff67a2de3f09cd3833</citedby><cites>FETCH-LOGICAL-c4033-99490693f13dd17f788143eea567ca4282f4b09f8ccb749ff67a2de3f09cd3833</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/40221947$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/40221947$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,780,784,803,27924,27925,58017,58250</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19536034$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hawker, Gillian A.</creatorcontrib><creatorcontrib>Badley, Elizabeth M.</creatorcontrib><creatorcontrib>Croxford, Ruth</creatorcontrib><creatorcontrib>Coyte, Peter C.</creatorcontrib><creatorcontrib>Glazier, Richard H.</creatorcontrib><creatorcontrib>Guan, Jun</creatorcontrib><creatorcontrib>Harvey, Bart J.</creatorcontrib><creatorcontrib>Williams, J. I.</creatorcontrib><creatorcontrib>Wright, James G.</creatorcontrib><title>A Population-Based Nested Case-Control Study of the Costs of Hip and Knee Replacement Surgery</title><title>Medical care</title><addtitle>Med Care</addtitle><description>Background: Studies of total joint arthroplasty (TJA) have not evaluated the costs and outcomes in the context of expected arthritis worsening. Objectives: Using a cost-consequence approach, to examine changes in direct health care costs and arthritis severity after TJA for hip/knee arthritis compared with contemporaneous changes in matched controls. Research Design: Case control study nested in a population-based prospective cohort. Subjects: In a population cohort with disabling hip/knee osteoarthritis followed from 1996 to 2003, primary TJA recipients were matched with cohort nonrecipients on age, sex, region of residence, comorbidity, and inflammatory arthritis diagnosis. Measures: Pre-and postoperative total and arthritis-attributable direct health care costs, arthritis severity, and general health status were compared for cases and matched controls. Results: Of 2109 participants with no prebaseline TJA, 185 cases received a single elective TJA during the follow-up period; of these, 183 cases and controls were successfully matched. Mean age was 71 years, 77.6% were female, 35.5% had ≥ 2 comorbidities, and 81.5% had ≥ 2 joints affected. At baseline, controls had less pain and disability and lower total and arthritis-attributable health care costs than cases. After surgery, although overall health care utilization was unchanged, cases experienced significant decreases in arthritis- attributable costs (mean decrease $278 including prescription drugs) and pain and disability (P < 0.0001 for all). Over the same time period, controls experienced a significant increase in total health care costs (mean increase $1978 including prescription drugs, P = 0.04) and no change or worsening of their arthritis status. Conclusion: Compared with matched controls, arthroplasty is associated with significant reductions in pain, disability, and arthritisattributable direct costs.</description><subject>Aged</subject><subject>Arthritis</subject><subject>Arthroplasty</subject><subject>Arthroplasty, Replacement, Hip - economics</subject><subject>Arthroplasty, Replacement, Knee - economics</subject><subject>Case-Control Studies</subject><subject>Community Health Planning</subject><subject>Comparative analysis</subject><subject>Cost control</subject><subject>Cost of Illness</subject><subject>Cost-Benefit Analysis</subject><subject>Disabilities</subject><subject>Disabled Persons - rehabilitation</subject><subject>Disabled Persons - statistics & numerical data</subject><subject>Female</subject><subject>Health care costs</subject><subject>Health Care Costs - statistics & numerical data</subject><subject>Health care expenditures</subject><subject>Health Services Research</subject><subject>Health Status</subject><subject>Humans</subject><subject>Joint replacement surgery</subject><subject>Knees</subject><subject>Male</subject><subject>National Health Programs - economics</subject><subject>National Health Programs - utilization</subject><subject>Ontario - epidemiology</subject><subject>Osteoarthritis, Hip - complications</subject><subject>Osteoarthritis, Hip - economics</subject><subject>Osteoarthritis, Hip - epidemiology</subject><subject>Osteoarthritis, Hip - surgery</subject><subject>Osteoarthritis, Knee - complications</subject><subject>Osteoarthritis, Knee - economics</subject><subject>Osteoarthritis, Knee - epidemiology</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>Pain - etiology</subject><subject>Pain - prevention & control</subject><subject>Physicians</subject><subject>Prescription drugs</subject><subject>Prospective Studies</subject><subject>Replacement value</subject><subject>Studies</subject><subject>Treatment Outcome</subject><issn>0025-7079</issn><issn>1537-1948</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtv1DAUhS0EotPCPwBksegu5foVx8s2AooYHmphiSxPcs3MkImD7aiaf4-rGYHUDaujI33n6OpcQl4wuGBg9JtPy5sLWAETKFjDjJBKiUdkwZTQFTOyeUwWAFxVGrQ5IacpbQGYFoo_JSfMKFGDkAvy45J-DdM8uLwJY3XlEvb0M6ZcpC2masOYYxjobZ77PQ2e5jXSNqSc7s31ZqJu7OnHEZHe4DS4Dnc4Zno7x58Y98_IE--GhM-Peka-v3v7rb2ull_ef2gvl1UnQYjKGGmgNsIz0fdMe900TApEp2rdOckb7uUKjG-6bqWl8b7WjvcoPJiuF40QZ-T80DvF8Hsu59vdJnU4DG7EMCdba8kUMCjg6wfgNsxxLLdZDloqDooVSB6gLoaUIno7xc3Oxb1lYO-3t2V7-3D7Ent17J5XO-z_hY5jF6A5AHdhyBjTr2G-w2jX6Ia8_l_3y0N0m3KIf6slcF5-rcUfwmSZXQ</recordid><startdate>20090701</startdate><enddate>20090701</enddate><creator>Hawker, Gillian A.</creator><creator>Badley, Elizabeth M.</creator><creator>Croxford, Ruth</creator><creator>Coyte, Peter C.</creator><creator>Glazier, Richard H.</creator><creator>Guan, Jun</creator><creator>Harvey, Bart J.</creator><creator>Williams, J. I.</creator><creator>Wright, James G.</creator><general>Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20090701</creationdate><title>A Population-Based Nested Case-Control Study of the Costs of Hip and Knee Replacement Surgery</title><author>Hawker, Gillian A. ; Badley, Elizabeth M. ; Croxford, Ruth ; Coyte, Peter C. ; Glazier, Richard H. ; Guan, Jun ; Harvey, Bart J. ; Williams, J. I. ; Wright, James G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4033-99490693f13dd17f788143eea567ca4282f4b09f8ccb749ff67a2de3f09cd3833</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Arthritis</topic><topic>Arthroplasty</topic><topic>Arthroplasty, Replacement, Hip - economics</topic><topic>Arthroplasty, Replacement, Knee - economics</topic><topic>Case-Control Studies</topic><topic>Community Health Planning</topic><topic>Comparative analysis</topic><topic>Cost control</topic><topic>Cost of Illness</topic><topic>Cost-Benefit Analysis</topic><topic>Disabilities</topic><topic>Disabled Persons - rehabilitation</topic><topic>Disabled Persons - statistics & numerical data</topic><topic>Female</topic><topic>Health care costs</topic><topic>Health Care Costs - statistics & numerical data</topic><topic>Health care expenditures</topic><topic>Health Services Research</topic><topic>Health Status</topic><topic>Humans</topic><topic>Joint replacement surgery</topic><topic>Knees</topic><topic>Male</topic><topic>National Health Programs - economics</topic><topic>National Health Programs - utilization</topic><topic>Ontario - epidemiology</topic><topic>Osteoarthritis, Hip - complications</topic><topic>Osteoarthritis, Hip - economics</topic><topic>Osteoarthritis, Hip - epidemiology</topic><topic>Osteoarthritis, Hip - surgery</topic><topic>Osteoarthritis, Knee - complications</topic><topic>Osteoarthritis, Knee - economics</topic><topic>Osteoarthritis, Knee - epidemiology</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>Pain - etiology</topic><topic>Pain - prevention & control</topic><topic>Physicians</topic><topic>Prescription drugs</topic><topic>Prospective Studies</topic><topic>Replacement value</topic><topic>Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hawker, Gillian A.</creatorcontrib><creatorcontrib>Badley, Elizabeth M.</creatorcontrib><creatorcontrib>Croxford, Ruth</creatorcontrib><creatorcontrib>Coyte, Peter C.</creatorcontrib><creatorcontrib>Glazier, Richard H.</creatorcontrib><creatorcontrib>Guan, Jun</creatorcontrib><creatorcontrib>Harvey, Bart J.</creatorcontrib><creatorcontrib>Williams, J. I.</creatorcontrib><creatorcontrib>Wright, James G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Medical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hawker, Gillian A.</au><au>Badley, Elizabeth M.</au><au>Croxford, Ruth</au><au>Coyte, Peter C.</au><au>Glazier, Richard H.</au><au>Guan, Jun</au><au>Harvey, Bart J.</au><au>Williams, J. I.</au><au>Wright, James G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Population-Based Nested Case-Control Study of the Costs of Hip and Knee Replacement Surgery</atitle><jtitle>Medical care</jtitle><addtitle>Med Care</addtitle><date>2009-07-01</date><risdate>2009</risdate><volume>47</volume><issue>7</issue><spage>732</spage><epage>741</epage><pages>732-741</pages><issn>0025-7079</issn><eissn>1537-1948</eissn><coden>MELAAD</coden><abstract>Background: Studies of total joint arthroplasty (TJA) have not evaluated the costs and outcomes in the context of expected arthritis worsening. Objectives: Using a cost-consequence approach, to examine changes in direct health care costs and arthritis severity after TJA for hip/knee arthritis compared with contemporaneous changes in matched controls. Research Design: Case control study nested in a population-based prospective cohort. Subjects: In a population cohort with disabling hip/knee osteoarthritis followed from 1996 to 2003, primary TJA recipients were matched with cohort nonrecipients on age, sex, region of residence, comorbidity, and inflammatory arthritis diagnosis. Measures: Pre-and postoperative total and arthritis-attributable direct health care costs, arthritis severity, and general health status were compared for cases and matched controls. Results: Of 2109 participants with no prebaseline TJA, 185 cases received a single elective TJA during the follow-up period; of these, 183 cases and controls were successfully matched. Mean age was 71 years, 77.6% were female, 35.5% had ≥ 2 comorbidities, and 81.5% had ≥ 2 joints affected. At baseline, controls had less pain and disability and lower total and arthritis-attributable health care costs than cases. After surgery, although overall health care utilization was unchanged, cases experienced significant decreases in arthritis- attributable costs (mean decrease $278 including prescription drugs) and pain and disability (P < 0.0001 for all). Over the same time period, controls experienced a significant increase in total health care costs (mean increase $1978 including prescription drugs, P = 0.04) and no change or worsening of their arthritis status. Conclusion: Compared with matched controls, arthroplasty is associated with significant reductions in pain, disability, and arthritisattributable direct costs.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>19536034</pmid><doi>10.1097/MLR.0b013e3181934553</doi><tpages>10</tpages></addata></record> |
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subjects | Aged Arthritis Arthroplasty Arthroplasty, Replacement, Hip - economics Arthroplasty, Replacement, Knee - economics Case-Control Studies Community Health Planning Comparative analysis Cost control Cost of Illness Cost-Benefit Analysis Disabilities Disabled Persons - rehabilitation Disabled Persons - statistics & numerical data Female Health care costs Health Care Costs - statistics & numerical data Health care expenditures Health Services Research Health Status Humans Joint replacement surgery Knees Male National Health Programs - economics National Health Programs - utilization Ontario - epidemiology Osteoarthritis, Hip - complications Osteoarthritis, Hip - economics Osteoarthritis, Hip - epidemiology Osteoarthritis, Hip - surgery Osteoarthritis, Knee - complications Osteoarthritis, Knee - economics Osteoarthritis, Knee - epidemiology Osteoarthritis, Knee - surgery Pain - etiology Pain - prevention & control Physicians Prescription drugs Prospective Studies Replacement value Studies Treatment Outcome |
title | A Population-Based Nested Case-Control Study of the Costs of Hip and Knee Replacement Surgery |
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