Costs of Nonoperative Procedures for Knee Osteoarthritis in the Year Prior to Primary Total Knee Arthroplasty

Background: The convergence of national priorities to reduce health-care costs and deliver high-value care warrants the need to examine health-care utilization. The objective of this study was to describe the costs associated with nonoperative procedures in the 1-year period leading up to primary total knee arthroplasty (TKA). Methods: An observational cohort study was conducted using the IBM Watson Health MarketScan databases. Patients with late-stage knee osteoarthritis (OA) who underwent unilateral, isolated primary TKA from January 1, 2018, to December 31, 2019, were included. The main outcome was the cost of knee OA-related payments for identified nonoperative procedures in the 1-year period before surgery. Nonoperative procedures examined were (1) physical therapy (PT); (2) bracing; (3) intra-articular injections: professional fee, hyaluronic acid (IA-HA), and corticosteroids (IA-CS); (4) medication: nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and acetaminophen; and (5) knee-specific imaging. Results: The study population included 24,492 TKA patients with a mean age of 60.4 +/- 8.0 years. The average total cost of nonoperative procedures per patient was $1,355 +/- $2,087. The most common nonoperative treatment prescribed was IA-CS (54.3%). The nonoperative procedure with the highest cost per patient was IA-HA ($1,019 +/- $913 per patient). The total cost of nonoperative procedures was higher among female compared with male patients ($1,440 +/- $2,159 versus $1,254 +/- $1,992 per patient; p < 0.01). The highest costs were found for patients in the Northeast ($1,740 +/- $2,437 per patient). A total of 14,346 (58.6%) and 7,831 (32.0%) of the patients had >1 and >= 3 nonoperative treatments, respectively. Conclusions: There is substantial variation in the type and the cost of nonoperative treatment for patients with late-stage OA. Future studies should investigate the effectiveness of nonoperative treatments at different stages of the disease.