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Publication In Arthritis Care & Research

  • January 24, 2018

Disparities in total knee replacement: Population losses in quality-adjusted life years due to differential offer, acceptance, and complication rates for Black Americans.

This article was published in January 2018 in Arthritis Care & Research.

Publication in Arthritis Care & Research

  • February 3, 2017

Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament (ACL) Tear in Early Adulthood

This article was published in February 2017 in Arthritis Care & Research.

Why ACL Tears Are Important for Knee Osteoarthritis

The incidence of ACL injuries is increasing; an estimated 5% of competitive year-round athletes experience an ACL injury each year. These injuries mostly occur in young, active people, and they have serious implications for developing knee OA later in life. However, because injuries occur many decades prior to OA development, studies estimating the lifetime risk of knee OA after injury are limited.

Study Design

We used the OAPol model to forecast the lifetime risk of knee OA and total knee replacement eligibility in persons with a complete ACL tear at age 25. We compared this to lifetime risk of knee OA and total knee replacement eligibility in an non-injured cohort.

Our Results

In our simulation model, people with ACL injury and meniscal tears had a 34% estimated lifetime risk of knee OA, while those who did not have injuries had a 14% lifetime risk of developing knee OA. Estimated lifetime risk of TKR was 22% for persons with ACL and meniscal tears, compared to 6% for those without injuries.

Publication in Arthritis Care & Research

  • February 3, 2017

Cost-effectiveness of tramadol and oxycodone in the treatment of knee osteoarthritis

This evaluation of the cost-effectiveness of two frequently used opioids was published in Arthritis Care & Research in February 2017.

Why Opioid Cost-Effectiveness Matters

The United States spends over 1.5 billion dollars on prescription opioids for knee OA patients, and the cost of illicit use of opioids has been estimated at over 28 billion dollars.  It is essential to understand if opioids are providing enough benefit to warrant these costs.

Study Design

We used the OAPol model to evaluate the cost effectiveness of tramadol and oxycodone in persons with no major comorbidities. We tested three treatment options: 1) no opioids; 2) tramadol; 3) tramadol followed by oxycodone.

Our Results

Neither tramadol nor tramadol plus oxycodone were cost-effective for knee OA in our base case, primarily because opioids worsen outcomes for total knee replacement. If patients are unwilling or unable to undergo total knee replacement, opioids may be cost-effective.

Publication in Arthritis Care & Research

  • December 1, 2016

The number of persons with symptomatic knee osteoarthritis in the United States: Impact of race/ethnicity, age, sex, and obesity

In this paper, published in December 2016 in Arthritis Care & Research, we used the OAPol model to estimate the number of persons with symptomatic knee OA in the United States.

Why This Estimate Matters

Previous estimates of the burden of knee osteoarthritis in the United States have not provided age and sex stratified estimates. Understanding the demographic characteristics of people with OA and severe OA will allow better predictions about what healthcare resources will be necessary in the coming years.

How the Study Was Designed

We used the National Health Interview Survey (NHIS) to calculated the proportion of adults with  knee OA in 2007-2008. We used the OAPol model and published data on knee OA progression to estimate the proportion of people living with severe OA. We then multiplied the proportions by population estimates from the US Census bureau.

Our Conclusions

We found that 14 million people have symptomatic knee OA, and half are under 65 years old. These results suggest that health care utilization for knee OA will increase over the coming decades and they emphasize the need for new prevention and treatment strategies.

Publication in Osteoarthritis & Cartilage

  • December 31, 2015

“Model-based evaluation of cost-effectiveness of nerve growth factor inhibitors in knee osteoarthritis: Impact of drug cost, toxicity, and means of administration” is an original research article examining the cost and toxicity thresholds under which a nerve growth factor inhibitor (NGF-i) would be a cost-effective treatment for knee OA patients. Given the high cost of drug administration in a hospital setting, we found that these agents are not cost-effective if they require intravenous hospital administration. However, if administration of the drug occurs at home and they are proven to have minimal effect on NGF-is could be a cost-effective treatment option

Publications in Osteoarthritis & Cartilage

  • November 30, 2015

“Cost-effectiveness of nonsteroidal anti-inflammatory drugs and opioids in the treatment of knee osteoarthritis in older patients with multiple comorbidities” was recently accepted at Osteoarthritis & Cartilage. In this manuscript, we used the OAPol Model to evaluate the long-term clinical and economic implications of using nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids in the treatment of knee OA patients who have multiple comorbid conditions, thereby increasing their risks for adverse events on both classes of analgesics. We found that, in this patient population, opioids lead to higher costs and reduced quality of life when compared to NSAIDs. In patients presenting with multiple comorbidities, naproxen- and ibuprofen-containing treatments are more effective in managing OA pain.

Publications in PLoS One

  • June 30, 2015

“Defining the value of future research to identify the preferred treatment of meniscal tear in the presence of knee osteoarthritis” is an original research article examining the long term clinical and economic outcomes of alternative treatment strategies for patients with concomitant mensical tear and knee osteoarthritis. We found that physical therapy alone is unlikely to be a cost-effective strategy and that, despite recent trials failing to show superiority of arthroscopic partial meniscetomy (APM), the current data do no support the rejection APM on a cost-effectiveness basis.

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