Osteoarthritis (OA) is a disorder that causes wear and tear of joints which leads to pain, stiffness, and limited mobility. In the UK, OA affects approximately 10 million people, with 5.4 million and 3.2 million affected by OA of the knee and hip, respectively.
Whilst there is no cure for OA, symptoms are managed through a combination of drug treatments, lifestyle changes and supportive therapies to ease everyday activities. In severe cases, where daily life is seriously affected, surgery is recommended to replace the joint with artificial parts through a joint replacement surgery. However, access to this surgery is not equal, depending upon ethnicity, living in deprived areas which affects access and time spent on surgery waiting lists, and subsequently healthcare service use. Patient weight limits are also in place for accessing surgery which are often difficult to achieve and further increase the inequalities.
Little research has been conducted in the UK assessing the time OA patients spend on waiting lists for joint replacement surgery, the healthcare services used during waiting times, and how patients’ weight impacts their care pathway. Through this study we aim to address these research gaps by describing the characteristics of patients diagnosed with OA of the knee or hip, time spent on surgery waiting lists, and healthcare services used from OA diagnosis through to surgery. We will also explore these further by ethnicity, geographical region, and level of deprivation, with the aim to advise clinical decisions for treating and managing patients with OA.
Aim: To evaluate waiting times and healthcare resource use (HCRU) and costs of patients with newly diagnosed knee or hip osteoarthritis (OA) awaiting total joint arthroplasty (TJA) in England.
Objectives: To describe i) waiting times and HCRU/costs from initial OA diagnosis to orthopaedic specialist referral, consultation and TJA surgery, by body mass index (BMI); ii) the proportion of patients changing BMI subgroup prior to TJA surgery, by pharmacological and lifestyle interventions, and comorbid type 2 diabetes; iii) baseline socio-demographic and clinical characteristics, by BMI. Waiting times prior to TJA surgery will be stratified by index year, ethnicity, geographic region, and socioeconomic status.
Methods: Retrospective cohort study of adults newly diagnosed with OA of the knee or hip between 2017-2018 (indexing period) using linked primary care (CRPD Aurum) and secondary data (HES). A minimum of 12-months’ data pre-index is required for inclusion, with variable follow-up (maximum 5-years with study period end of 31st December 2023). Patients with prior joint replacements or private healthcare will be excluded.
Exposures: OA of the knee or hip, BMI (at OA diagnosis), pharmacological and lifestyle interventions following OA diagnosis.
Outcomes: Time-to-first referral to orthopaedic specialist, time-to-first orthopaedic specialist consultation, time-to-first TJA surgery, HCRU/ costs, change in BMI, mortality, socio-demographic and clinical characteristics.
Data Analysis: Counts, mean, standard deviation, medians, interquartile range and minimum/maximum values will be reported for numeric variables; frequencies and proportions for categorical variables. Rates will be calculated by dividing frequency of events by person time at-risk. Kaplan-Meier plots visualising time-to-events and Kaplan-Meier estimates of survivor function and cumulative hazard rate will be outputted.
Public benefit: Waiting times for joint replacement surgery among OA patients will be reported according to BMI groups, ethnicity, socioeconomic status and geographical regions. As such, care disparities may be found, providing evidence to optimise management and resource allocation.
Time-to-first referral to orthopaedic specialist; time-to-first orthopaedic specialist consultation; time-to-first TJA surgery; healthcare resource use (primary care consultations; outpatient attendances; inpatient stays; A&E visits; physiotherapy and counselling services; and prescriptions written in primary care); all-cause healthcare costs (by care setting and total); change in BMI classification; all-cause mortality; socio-demographic and clinical characteristics.
Caroline Casey - Chief Investigator - Eli Lilly and Company Ltd. (UK)
Zohaib Akhter - Corresponding Applicant - Adelphi Real World
Alun Davies - Collaborator - Eli Lilly & Co - UK
Laurienne Edgar - Collaborator - Eli Lilly & Co - UK
Olivia Massey - Collaborator - Adelphi Real World
Robert Wood - Collaborator - Adelphi Real World
Thomas Jennison - Collaborator - Adelphi Real World
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation