A comparison of three strategies to reduce the burden of osteoarthritis: A population-based microsimulation study

Abstract

Objectives: The purpose of this study was to compare three strategies for reducing population health burden of osteoarthritis (OA): improved pharmacological treatment of OA-related pain, improved access to joint replacement surgery, and prevention of OA by reducing obesity and overweight.

Methods: We applied a validated computer microsimulation model of OA in Canada. The model simulated a Canadian-representative open population aged 20 years and older. Variables in the model included demographics, body mass index, OA diagnosis, OA treatment, mortality, and health-related quality of life. Model parameters were derived from analyses of national surveys, population-based administrative data, a hospital-based cohort study, and the literature. We compared 8 what-if intervention scenarios in terms of disability-adjusted life years (DALYs) relative to base-case, over a wide range of time horizons.

Results: Reductions in DALYs depended on the type of intervention, magnitude of the intervention, and the time horizon. Medical interventions (a targeted increase in the use of painkillers) tended to produce effects quickly and were, therefore, most effective over a short time horizon (a decade). Surgical interventions (increased access to joint replacement) were most effective over a medium time horizon (two decades or longer). Preventive interventions required a substantial change in BMI to generate a significant impact, but produced more reduction in DALYs than treatment strategies over a very long time horizon (several decades).

Conclusions: In this population-based modeling study we assessed the potential impact of three different burden reduction strategies in OA. Data generated by our model may help inform the implementation of strategies to reduce the burden of OA in Canada and elsewhere.

Fig 1. Use of four classes of analgesics before and after Medication x2 and Medication x3 interventions in people with osteoarthritis.

All interventions are described in Table 1.

Fig 2. Joint replacement rates before and after Surgery x2 and Surgery x3 interventions in people with osteoarthritis.

All interventions are described in Table 1.

Fig 3. Percentage obese and overweight in the population under four preventive intervention scenarios.

All interventions are described in Table 1.

Fig 4. Mean HUI3 among persons with osteoarthritis before and after each intervention.

HUI3, Health Utilities Index Mark 3. All interventions are described in Table 1. The trend in HUI3 may appear steep because the Y-axis range was restricted to better visualize the impact of interventions.

Fig 5. Total cumulative reductions in OA-related DALYs (DALYs averted) from 8 interventions in the simulated population.

DALYs, disability-adjusted life years. OA, osteoarthritis. All interventions are described in Table 1.

Fig 6. DALYs averted due to 8 interventions as a percentage of all OA-related DALYs, relative to base-case, over an 80-year time horizon.

DALYs, disability-adjusted life years. OA, osteoarthritis. All interventions are described in Table 1.