COST PATTERNS FOLLOWING THE DIAGNOSIS OF KNEE OSTEOARTHRITIS IN THE - - PowerPoint PPT Presentation

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COST PATTERNS FOLLOWING THE DIAGNOSIS OF KNEE OSTEOARTHRITIS IN THE BLUE CROSS/BLUE SHIELD PATIENT POPULATION KEVIN L. ONG 1 , FAIZAN NIAZI 2 , EDMUND LAU 3 , PETER SHAW 2 , STEVEN M. KURTZ 1 1 EXPONENT, INC., PHILADELPHIA, PA; 2 FERRING

SLIDE 1

COST PATTERNS FOLLOWING THE DIAGNOSIS OF KNEE OSTEOARTHRITIS IN THE BLUE CROSS/BLUE SHIELD PATIENT POPULATION

KEVIN L. ONG1, FAIZAN NIAZI2, EDMUND LAU3, PETER SHAW2, STEVEN M. KURTZ1

1EXPONENT, INC., PHILADELPHIA, PA; 2FERRING PHARMACEUTICALS, INC., PARSIPPANY, NJ; 3EXPONENT, INC., MENLO

PARK, CA PRESENTED BY: JIMMY ZHU, M.D. DEPARTMENT OF ORTHOPAEDICS AND SPORTS MEDICINE, UNIVERSITY OF WASHINGTON OSET 2017

SLIDE 2

DISCLOSURES

 Kevin L. Ong, Edmund Lau, Steven M. Kurtz: employees of Exponent; Exponent received

funding from Ferring Pharmaceuticals, Inc. for this study

 Faizan Niazi, Peter Shaw: employees of Ferring Pharmaceuticals, Inc.  Jimmy Zhu: nothing to disclose

SLIDE 3

INTRODUCTION

 Knee osteoarthritis (OA) contributes >$27B in annual healthcare costs1  Previous cost studies primarily focused on expenditures leading up to TKA, but not the entire episode

f care2,3

 Restricting conservative treatment options has been estimated to lower the average patient age for

TKA, increase TKA uptake, and increase lifetime medical costs by 29%4

 The projected increased utilization of TKA will fuel healthcare costs5

1Arthritis Foundation 2Bedard et al. J Arthroplasty, 2017 3Cohen et al. J Arthroplasty, 2016 4Losina et al., Arthritis Care Res, 2015 5Kurtz et al., J Bone Join Surg Am, 2014

SLIDE 4

INTRODUCTION

Study Goals

 To evaluate the temporal trends in treatment costs following knee OA diagnosis  To evaluate whether these trends are different for patients who use intra-articular hyaluronic acid

(HA) and/or knee arthroplasty

Data Source

 Blue Health Intelligence (BHI) claims data  140M+ unique BCBS members nationwide  Captures medical/prescription claims and membership/provider data

SLIDE 5

METHODS

 Newly-diagnosed knee OA patients identified from BHI data (2011-2015) with a

minimum of 6 months continuous enrollment during study period

 Cohort identification included:



With and without knee arthroplasty



With and without HA

Without Knee Arthroplasty With Knee Arthroplasty No HA n=1,247,689 (92.4%) n=102,812 (7.6%) HA n=180,862 (83.5%) n=35,661 (16.5%)

SLIDE 6

METHODS

Cost Analysis

 Knee OA-related claims were compiled until end 2015  Based on diagnosis of knee OA on any claims  Cumulative costs (in terms of payments adjusted to Nov 2016 dollars) were determined on a monthly

basis until end 2015 or end of enrollment

 Included any knee OA-related costs post-knee arthroplasty for those with knee arthroplasty  Stratify into various cost categories, including knee arthroplasty and HA

SLIDE 7

RESULTS

Cumulative Cost Per Patient (Median): KA vs. no KA (without HA)

 Increase in cost reflects use of

knee arthroplasty

SLIDE 8

RESULTS

Cumulative Cost Per Patient (Median): HA vs. no HA (with KA)

 Time-shift in cost curves for HA vs.

no HA reflects delay to KA

 Cost savings from the delay to KA



Median cost at 1 year was $22,952 for patients without HA who went on to knee arthroplasty versus $3,230 for their HA counterparts

SLIDE 9

RESULTS

Cumulative Cost Per Patient (Median): KA vs. no KA (without HA)

 The median costs at the 4 year

time-point increased by $32,031 when patients without HA also underwent knee arthroplasty

SLIDE 10

RESULTS

Cumulative Cost Per Patient (Median): KA vs. no KA (with HA)

 The median costs at the 4 year

time-point increased by $32,241 when patients with HA also underwent knee arthroplasty

SLIDE 11

DISCUSSION

 Among patients who went on to knee arthroplasty, those with HA experienced

elevated costs from the surgery later than those without HA, which reflects the longer time to knee arthroplasty for the HA patients.

 Regardless of whether the patients used HA or not, those with knee arthroplasty had

greater median costs of about $32,000 at 4 years post-knee OA diagnosis

 Others have reported that 29.3% of costs are due to HA, but limited to:

 12 months prior to TKA  Non-inpatient costs  Non-surgical costs (e.g. no arthroscopy, no TKA)

1Bedard et al. J Arthroplasty, 2017

SLIDE 12

SIGNIFICANCE

 Most HA patients avoided primary knee arthroplasty during the study period  The ability to delay or avoid knee arthroplasty altogether can have a substantial impact

n the cost to the healthcare system

COST PATTERNS FOLLOWING THE DIAGNOSIS OF KNEE OSTEOARTHRITIS IN THE BLUE CROSS/BLUE SHIELD PATIENT POPULATION

DISCLOSURES

 Kevin L. Ong, Edmund Lau, Steven M. Kurtz: employees of Exponent; Exponent received

funding from Ferring Pharmaceuticals, Inc. for this study

 Faizan Niazi, Peter Shaw: employees of Ferring Pharmaceuticals, Inc.  Jimmy Zhu: nothing to disclose

INTRODUCTION

 Knee osteoarthritis (OA) contributes >$27B in annual healthcare costs1  Previous cost studies primarily focused on expenditures leading up to TKA, but not the entire episode

 Restricting conservative treatment options has been estimated to lower the average patient age for

TKA, increase TKA uptake, and increase lifetime medical costs by 29%4

 The projected increased utilization of TKA will fuel healthcare costs5

INTRODUCTION

Study Goals

 To evaluate the temporal trends in treatment costs following knee OA diagnosis  To evaluate whether these trends are different for patients who use intra-articular hyaluronic acid

(HA) and/or knee arthroplasty

Data Source

 Blue Health Intelligence (BHI) claims data  140M+ unique BCBS members nationwide  Captures medical/prescription claims and membership/provider data

METHODS

 Newly-diagnosed knee OA patients identified from BHI data (2011-2015) with a

minimum of 6 months continuous enrollment during study period

 Cohort identification included:

With and without knee arthroplasty

With and without HA

Without Knee Arthroplasty With Knee Arthroplasty No HA n=1,247,689 (92.4%) n=102,812 (7.6%) HA n=180,862 (83.5%) n=35,661 (16.5%)

METHODS

Cost Analysis

 Knee OA-related claims were compiled until end 2015  Based on diagnosis of knee OA on any claims  Cumulative costs (in terms of payments adjusted to Nov 2016 dollars) were determined on a monthly

basis until end 2015 or end of enrollment

 Included any knee OA-related costs post-knee arthroplasty for those with knee arthroplasty  Stratify into various cost categories, including knee arthroplasty and HA

RESULTS

Cumulative Cost Per Patient (Median): KA vs. no KA (without HA)

 Increase in cost reflects use of

knee arthroplasty

RESULTS

Cumulative Cost Per Patient (Median): HA vs. no HA (with KA)

 Time-shift in cost curves for HA vs.

no HA reflects delay to KA

 Cost savings from the delay to KA

Median cost at 1 year was $22,952 for patients without HA who went on to knee arthroplasty versus $3,230 for their HA counterparts

RESULTS

Cumulative Cost Per Patient (Median): KA vs. no KA (without HA)

 The median costs at the 4 year

time-point increased by $32,031 when patients without HA also underwent knee arthroplasty

RESULTS

Cumulative Cost Per Patient (Median): KA vs. no KA (with HA)

 The median costs at the 4 year

time-point increased by $32,241 when patients with HA also underwent knee arthroplasty

DISCUSSION

 Among patients who went on to knee arthroplasty, those with HA experienced

elevated costs from the surgery later than those without HA, which reflects the longer time to knee arthroplasty for the HA patients.

 Regardless of whether the patients used HA or not, those with knee arthroplasty had

greater median costs of about $32,000 at 4 years post-knee OA diagnosis

 Others have reported that 29.3% of costs are due to HA, but limited to:

 12 months prior to TKA  Non-inpatient costs  Non-surgical costs (e.g. no arthroscopy, no TKA)

SIGNIFICANCE

 Most HA patients avoided primary knee arthroplasty during the study period  The ability to delay or avoid knee arthroplasty altogether can have a substantial impact

 With the wide spectrum of therapies to treat knee OA, efforts to identify the most

appropriate candidates for arthroplasty and non-arthroplasty therapies can help reduce costs to the healthcare system