Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Dec;55(12):993-1000.
doi: 10.1097/MLR.0000000000000816.

A Fresh Perspective on a Familiar Problem: Examining Disparities in Knee Osteoarthritis Using a Markov Model

Taruja D Karmarkar  1 , Anne Maurer, Michael L Parks, Thomas Mason, Ana Bejinez-Eastman, Melvyn Harrington, Randall Morgan, Mary I O'Connor, James E Wood, Darrell J Gaskin
Affiliations
Review

A Fresh Perspective on a Familiar Problem: Examining Disparities in Knee Osteoarthritis Using a Markov Model

Taruja D Karmarkar et al. Med Care. 2017 Dec.

Abstract

Background: Disparities in the presentation of knee osteoarthritis (OA) and in the utilization of treatment across sex, racial, and ethnic groups in the United States are well documented.

Objectives: We used a Markov model to calculate lifetime costs of knee OA treatment. We then used the model results to compute costs of disparities in treatment by race, ethnicity, sex, and socioeconomic status.

Research design: We used the literature to construct a Markov Model of knee OA and publicly available data to create the model parameters and patient populations of interest. An expert panel of physicians, who treated a large number of patients with knee OA, constructed treatment pathways. Direct costs were based on the literature and indirect costs were derived from the Medical Expenditure Panel Survey.

Results: We found that failing to obtain effective treatment increased costs and limited benefits for all groups. Delaying treatment imposed a greater cost across all groups and decreased benefits. Lost income because of lower labor market productivity comprised a substantial proportion of the lifetime costs of knee OA. Population simulations demonstrated that as the diversity of the US population increases, the societal costs of racial and ethnic disparities in treatment utilization for knee OA will increase.

Conclusions: Our results show that disparities in treatment of knee OA are costly. All stakeholders involved in treatment decisions for knee OA patients should consider costs associated with delaying and forgoing treatment, especially for disadvantaged populations. Such decisions may lead to higher costs and worse health outcomes.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Markov model diagram.
FIGURE 2
FIGURE 2
Lifetime costs and QALYs of treatment for healthy and comorbid patients. QALYs indicates quality-adjusted life-years.
See this image and copyright information in PMC

References

    1. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis—Eular J. 2014;73:1323–1330. - PubMed
    1. Losina E, Walensky RP, Kessler CL, et al. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med. 2009;169:1113–1121. - PMC - PubMed
    1. Gaskin DJ, Richard P. The economic costs of pain in the United States. Institute of Medicine: Institute of Medicine. 2011. Available at: https://www.ncbi.nlm.nih.gov/books/NBK92521/.
    1. LaVeist TA, Gaskin D, Richard P. Estimating the economic burden of racial health inequalities in the United States. Int J Health Serv. 2011;41:231–238. - PubMed
    1. American College of Rheumatology A. Race and gender: key factors in lifetime knee osteoarthritis risk; African-American women most at risk. Available at: http://www.sciencedaily.com/releases/2012/11/121111153520.htm. Accessed November 11, 2012.

Publication types