Estimating Budget Impact and Joint Replacement Avoidance by Implementing a Standardized Education and Exercise Therapy Program for Hip and Knee Osteoarthritis in a Publicly Insured Health Care System.

Abstract

Objective: The study objective was to estimate the budget impact of funding a standardized education and exercise therapy program, Good Life with osteoArthritis in Denmark (GLA:D) for people with hip and knee osteoarthritis (OA) waiting for total joint replacement (TJR) consultation in a universal publicly insured health care system in Canada.

Methods: We built a budget impact analysis model to estimate the annual cost (Canadian dollars) of providing the GLA:D program to people waiting for a TJR consultation and then forecasted a three-year budget cycle. The base case assumes that 40% attend GLA:D sessions, that 11% avoid surgery, uniform care delivery, that training costs are incurred separately, and that the health care system has enough trained staff to meet demand. The population of people with hip and knee OA waiting for a TJR consultation was estimated with government statistics, peer-reviewed evidence, and routinely collected data from five orthopedic centralized intake clinics (serving 80% of people seeking TJR). Patient-level costs were collected prospectively. International published evidence informed the TJR avoidance estimates. A one-way sensitivity analysis of key parameters evaluated model robustness. Four scenarios were analyzed: public funding for everyone (base case), low-income, rural, and uninsured persons.

Results: Funding GLA:D would cost $4.3 million, serve 12,500 people, and save $8.5 million by avoiding 1,300 TJRs in year one. Savings grow to $8.8 and $8.7 million in years two and three. The number of TJRs performed annually produced the most uncertainty in budget impact (-$15.3 million, -$1.8 million). The most cautious parameter estimates still produce cost savings.

Conclusion: Publicly funding standardized education and exercise therapy programs for everyone waiting for a TJR consultation would avoid surgeries, improve access to evidence-based treatments, and save more than the program costs.