Below you will find brief descriptions of several of our exciting ongoing analyses. To learn more about our past, published work, please refer to the Publications page.
The Cost-effectiveness of GLP-1 RAs for Patients with Knee Osteoarthritis and Obesity
Obesity increases the risk of developing knee osteoarthritis (OA). Studies have shown that weight loss can reduce knee joint loading, systematic inflammation, and knee pain in individuals with OA and obesity. Semaglutide and tirzepatide were FDA-approved in 2021 and 2023, respectively, as pharmacological interventions which lead to rapid and substantial weight loss and have become widely used. However, they may carry the risk of gastrointestinal side effects and are expensive. In light of the clinical benefits, risk of adverse events, and high costs of GLP1RAs, this analysis aims to evaluate the cost-effectiveness of adding GLP1RAs compared to other common weight-loss interventions (surgical and lifestyle-based) to care for patients with symptomatic knee OA and obesity under a variety of clinical circumstances. Future analyses may investigate whether the high cost of GLP1RAs imposes differential ability to access them and if so, the resulting tradeoff between general population health improvements and increased health disparities.
Cost-Effectiveness of Arthroscopic Partial Meniscectomy for Meniscal Tear (13-year Follow-up)
Arthroscopic partial meniscectomy (APM) is a common treatment for persons with concomitant degenerative meniscal tear and knee osteoarthritis (OA). However, a growing body of randomized clinical trials suggests that APM only provides marginally better benefits than physical therapy or sham surgery, if any. Clinical applications are limited by the fact that randomized clinical trials experience a large proportion of cross-over between treatment arms. To address this limitation, we use simulation modeling on a variety of time horizons including two, five, and thirteen years to evaluate the cost-effectiveness of APM versus immediate physical therapy when patients adhere to treatment assignments.
Cost-Effectiveness of Physical Therapy for Meniscal Tear
Symptomatic knee osteoarthritis (OA) is a common, disabling condition. Many patients with knee OA also have meniscal tear. While there are no authoritative guidelines directing the care of patients with symptomatic meniscal tear, many clinicians initially refer such patients for a physical therapy (PT) regimen focused on strengthening exercises. The TeMPO trial was designed to test the efficacy of a typical PT regimen compared to placebo PT or home exercise alone in patients with radiographic OA and symptomatic meniscal tear. We used the Osteoarthritis Policy (OAPol) Model to investigate the cost-effectiveness of the interventions conducted in the TeMPO trial.
Distributional Cost-Effectiveness of Physical Activity Regimens for Knee Osteoarthritis
Physical activity has been shown to improve symptomatic knee osteoarthritis (OA), but many Americans struggle to achieve the level of exercise recommended by professionals. Additionally, individuals of low socioeconomic status are less likely to be physically active or to adhere to interventions which boost physical activity than individuals of high socioeconomic status. The aim of the physical activity distributional cost-effectiveness analysis is to determine the value of programs which promote exercise in the knee OA population, especially among individuals of low socioeconomic status, with the goal of reducing knee osteoarthritis-related health inequities.
Cost-Effectiveness of Same-day TKR for Knee Osteoarthritis
In January 2018, the Centers for Medicare and Medicaid Services removed total knee replacement (TKR) from the inpatient-only list. With such a change and advancements in hospitals, more and more TKR procedures are shifting towards outpatient services. While there are benefits for patients to receiving outpatient TKR, it is important for hospitals to provide care that prioritizes the safety of patients and effectiveness of procedures. As a result, we are conducting a target trial emulation to compare the patient outcomes of outpatient versus inpatient TKR. In addition, we will examine the cost effectiveness of outpatient versus inpatient TKR. The findings will inform clinical decision-making and healthcare policy regarding the safety and cost-effectiveness of outpatient versus inpatient stay for patients receiving elective TKR.
Cost-Effectiveness of Telemedicine for Knee Osteoarthritis
Ever since the COVID-19 pandemic, telemedicine has taken off as an alternative to traditional in-person care for many conditions, including knee OA. However, while telemedicine is often convenient, its successful adoption as a common and cost-effective practice depends on patients’ digital access and providers’ understanding of how to integrate telemedicine in the continuum of OA care. In this analysis, we aim to establish the cost-effectiveness of various telemedicine programs as well as estimate the value of programs to improve access and uptake of telemedicine among patients with low educational attainment and knee OA.