Browsing by Author "Mazzei, Darren Randell"

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    The Need, Value and Affordability of First-line Treatments for Hip and Knee Osteoarthritis in Alberta
    (2024-04-24) Mazzei, Darren Randell; Marshall, Deborah; Whittaker, Jackie; Faris, Peter; Wasylak, Tracy
    Clinical guidelines have recommended exercise and education as first-line treatments for hip and knee osteoarthritis (OA) for 25 years, but these proven treatments are underused globally. In Alberta, joint replacements are publicly funded. Meanwhile, first-line treatments are funded with private insurance or out-of-pocket which reduces access. We sought to inform the policy-making process in Alberta by addressing three objectives: 1) Describe “usual care” (UC) patterns of education, exercise, weight management, pain medication and other nonsurgical treatments for knee OA in a cohort of people recommended for nonsurgical care by an orthopaedic surgeon; 2) Estimate the real-world incremental net monetary benefit (INMB) of a standardized education and exercise therapy program (GLA:D®) compared to usual care for people managing hip and/or knee OA; 3) Estimate the budget impact of funding GLA:D® for people with hip and knee OA waiting for total joint replacement (TJR) consultation in a universal publicly insured healthcare system. We surveyed 250 people over the telephone and found that only 20% of people used treatments consistent with international clinical guidelines during a three-to-six-year period after an orthopaedic surgeon recommended nonsurgical care. Our prospective matched cohort study (GLA:D® n=127, UC n=127) showed that GLA:D® had a positive INMB compared to UC from the Ministry of Health perspective over 12-months. The INMB of GLA:D® was still positive but less certain over a lifetime as well as when out-of-pocket and private insurance costs were considered. Our budget impact analysis model showed that publicly funding GLA:D® for everyone waiting for TJR consultation could be an affordable solution to avoid surgeries, improve equitable access to evidence-based treatments and save more than the program costs. Our research shows that publicly funding GLA:D® would increase use of first-line treatments in Alberta by filling an important care gap, offer more equitable access to evidence-based care, reduce significant out-of-pocket expenses for people living with OA and improve health system performance.