Disparity of health services in patients with knee osteoarthritis before total knee arthroplasty

Abstract

Background: Recent evidence describes which interventions are driving insurance payments in the management of osteoarthritis (OA) before total knee arthroplasty (TKA); however, relatively little is known about how these costs are distributed among patients. Methods: We reviewed the Humana claims database for patients who underwent primary TKA from 2009 to 2016. Insurance payments for treatment, imaging, and evaluation and management were calculated from OA diagnosis to TKA, the distribution of payments was determined, and a high-payment group was identified by determining the point at which patients began to account for a disproportionate percentage of payments. This group of high-payment patients was compared with remaining patients (low-payment patients) based on demographic factors and nonarthroplasty payments and utilization. Results: The top 30% of patients accounted for more than 70% of nonarthroplasty payments. High-payment patients were more likely to be younger, female, and more comorbid. Median time from diagnosis to TKA for high-payment patients was 3 times longer than that for low-payment patients (654 days [320-1191] vs 204 days [68-582], P < .001), and median payment per patient was more than 5 times higher ($1891 [1405-2782] vs $362 [198-613], P < .001). Conclusions: Identification of high-payment patients in the management of knee OA may allow for targeted care pathways and cost-reduction strategies in the nonarthroplasty period, although additional studies are necessary to further characterize this population and efficiently recognize appropriate TKA candidates and timing. Keywords: Osteoarthritis, Total knee arthroplasty, Health insurance, Reimbursement payments, Cost distribution