A nationwide analysis of socioeconomic outcomes after hip and knee replacement

TY - JOUR

T1 - A nationwide analysis of socioeconomic outcomes after hip and knee replacement

AU - Kjellberg, Jakob

AU - Kehlet, Henrik

PY - 2015/8

Y1 - 2015/8

N2 - Introduction: Total hip and knee replacement (THA and TKA) are successful operations based on patient-reported outcomes and short-term socioeconomic evaluations. However, other data have shown problems regarding persistent pain and function. No detailed large-scale, long-term socioeconomic data exist on income and total health expenses before and after THA and TKA compared with a matched reference population (RP). Methods: From the unique nationwide Danish registers, a total of 128,109 patients undergoing primary THA and TKA were followed from up to 12 years before to up to 12 years after surgery. The economic analysis of the total costs before and after surgery were divided into annual healthcare costs (outpatient services, inpatient admissions, prescription drugs and physician office visits), home care and loss of income and compared with a matched RP. Results: Healthcare costs increased by about 10,000 € in the year of surgery followed by an increase of about 6,000 €/yr/patient in both operations due to a loss of employment income, a need for home care and the use of medications, also compared with an RP. Survival was slightly better for patients than for the RP, suggesting that severe co-mor-bidities have only a limited role in explaining the increased costs. Conclusions: The healthcare costs and income of patients undergoing THA and TKA are comparable to those of their matched RP until three years before the operation, but TKA and THA patients continuously have higher healthcare costs and lower income levels than the RP after surgery. These data should be taken into account in future studies of patient expectations and strategies for enhanced rehabilitation.

AB - Introduction: Total hip and knee replacement (THA and TKA) are successful operations based on patient-reported outcomes and short-term socioeconomic evaluations. However, other data have shown problems regarding persistent pain and function. No detailed large-scale, long-term socioeconomic data exist on income and total health expenses before and after THA and TKA compared with a matched reference population (RP). Methods: From the unique nationwide Danish registers, a total of 128,109 patients undergoing primary THA and TKA were followed from up to 12 years before to up to 12 years after surgery. The economic analysis of the total costs before and after surgery were divided into annual healthcare costs (outpatient services, inpatient admissions, prescription drugs and physician office visits), home care and loss of income and compared with a matched RP. Results: Healthcare costs increased by about 10,000 € in the year of surgery followed by an increase of about 6,000 €/yr/patient in both operations due to a loss of employment income, a need for home care and the use of medications, also compared with an RP. Survival was slightly better for patients than for the RP, suggesting that severe co-mor-bidities have only a limited role in explaining the increased costs. Conclusions: The healthcare costs and income of patients undergoing THA and TKA are comparable to those of their matched RP until three years before the operation, but TKA and THA patients continuously have higher healthcare costs and lower income levels than the RP after surgery. These data should be taken into account in future studies of patient expectations and strategies for enhanced rehabilitation.

KW - Adult

KW - Arthroplasty, Replacement, Hip

KW - Arthroplasty, Replacement, Knee

KW - Cost-Benefit Analysis

KW - Denmark

KW - Female

KW - Forecasting

KW - Health Care Costs

KW - Humans

KW - Male

KW - Middle Aged

KW - Registries

KW - Journal Article

KW - Multicenter Study

M3 - Journal article

C2 - 27477795

SN - 2245-1919

VL - 63

JO - Danish Medical Journal

JF - Danish Medical Journal

IS - 8

M1 - A5257

ER -