Marshall, DeborahMazzei, Darren Randell2024-04-302024-04-302024-04-24Mazzei, 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.https://hdl.handle.net/1880/118525https://doi.org/10.11575/PRISM/43367Clinical 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.enUniversity 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.Health economicsEconomic evaluationCost-effectiveness analysisBudget impact analysisOsteoarthritisHipKneeEducationExercise therapyHome Economicsdoctoral thesis