The Need, Value and Affordability of First-line Treatments for Hip and Knee Osteoarthritis in Alberta

Mazzei, Darren Randell

The Need, Value and Affordability of First-line Treatments for Hip and Knee Osteoarthritis in Alberta

dc.contributor.advisor	Marshall, Deborah
dc.contributor.author	Mazzei, Darren Randell
dc.contributor.committeemember	Whittaker, Jackie
dc.contributor.committeemember	Faris, Peter
dc.contributor.committeemember	Wasylak, Tracy
dc.date	2024-05
dc.date.accessioned	2024-04-30T20:51:02Z
dc.date.available	2024-04-30T20:51:02Z
dc.date.issued	2024-04-24
dc.description.abstract	Clinical guidelines have recommended exercise and education as first-line treatments for hip and knee osteoarthritis (OA) for 25 years, but these proven treatments are underused globally. In Alberta, joint replacements are publicly funded. Meanwhile, first-line treatments are funded with private insurance or out-of-pocket which reduces access. We sought to inform the policy-making process in Alberta by addressing three objectives: 1) Describe “usual care” (UC) patterns of education, exercise, weight management, pain medication and other nonsurgical treatments for knee OA in a cohort of people recommended for nonsurgical care by an orthopaedic surgeon; 2) Estimate the real-world incremental net monetary benefit (INMB) of a standardized education and exercise therapy program (GLA:D®) compared to usual care for people managing hip and/or knee OA; 3) Estimate the budget impact of funding GLA:D® for people with hip and knee OA waiting for total joint replacement (TJR) consultation in a universal publicly insured healthcare system. We surveyed 250 people over the telephone and found that only 20% of people used treatments consistent with international clinical guidelines during a three-to-six-year period after an orthopaedic surgeon recommended nonsurgical care. Our prospective matched cohort study (GLA:D® n=127, UC n=127) showed that GLA:D® had a positive INMB compared to UC from the Ministry of Health perspective over 12-months. The INMB of GLA:D® was still positive but less certain over a lifetime as well as when out-of-pocket and private insurance costs were considered. Our budget impact analysis model showed that publicly funding GLA:D® for everyone waiting for TJR consultation could be an affordable solution to avoid surgeries, improve equitable access to evidence-based treatments and save more than the program costs. Our research shows that publicly funding GLA:D® would increase use of first-line treatments in Alberta by filling an important care gap, offer more equitable access to evidence-based care, reduce significant out-of-pocket expenses for people living with OA and improve health system performance.
dc.identifier.citation	Mazzei, D. R. (2024). The need, value and affordability of first-line treatments for hip and knee osteoarthritis in Alberta (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.
dc.identifier.uri	https://hdl.handle.net/1880/118525
dc.language.iso	en
dc.publisher.faculty	Cumming School of Medicine
dc.publisher.institution	University of Calgary
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subject	Health economics
dc.subject	Economic evaluation
dc.subject	Cost-effectiveness analysis
dc.subject	Budget impact analysis
dc.subject	Osteoarthritis
dc.subject	Hip
dc.subject	Knee
dc.subject	Education
dc.subject	Exercise therapy
dc.subject.classification	Home Economics
dc.title	The Need, Value and Affordability of First-line Treatments for Hip and Knee Osteoarthritis in Alberta
dc.type	doctoral thesis
thesis.degree.discipline	Medicine – Community Health Sciences
thesis.degree.grantor	University of Calgary
thesis.degree.name	Doctor of Philosophy (PhD)
ucalgary.thesis.accesssetbystudent	I do not require a thesis withhold – my thesis will have open access and can be viewed and downloaded publicly as soon as possible.