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Objective: Little is known about the burden of osteoarthritis (OA) in Canada. This study was undertaken to estimate the excess burden of OA in Ontario, the largest province in Canada., Methods: The records of Ontarian respondents to the Canadian Community Health Survey (CCHS) who provided consent to data linkage were linked to the Ontario Health Insurance Program physician claims database and the Discharge Abstract Database Inpatient and Day Procedure databases. Patients with OA (n = 1,474) were identified using CCHS 1.1 and the physician claims database. To determine the excess burden of OA, a control group matched by age, sex, and rural/urban status was created, with 3 controls per case (n = 4,422). Sociodemographic and medical characteristics, health-related quality of life, and 1-year physician, day (outpatient) procedure, and hospitalization costs were compared between the 2 groups. Regression analyses were performed to identify predictors of medical characteristics, health utility, and cost., Results: The mean age of the OA patients and the control subjects was 66 years, and 74% of all study subjects were women. Several differences were observed between patients with OA and subjects without OA in terms of socioeconomic and medical characteristics. On a scale of 0-1, the mean utility value associated with OA was 0.68, compared to 0.84 for the control group (P < 0.0001), representing a utility decrement of 0.16. The 1-year physician, outpatient procedure, and hospitalization costs were significantly higher in the OA group than in the non-OA group ($2,233 Canadian versus $1,033 Canadian, respectively; P < 0.0001)., Conclusion: These results indicate that the excess burden of OA in Ontario is considerable., (Copyright © 2012 by the American College of Rheumatology.)

The objective of this study was to evaluate incremental cost-utility of total knee replacement (TKR) versus unicompartmental knee arthroplasty (UKA) in patients with knee osteoarthritis (OA) of the medial compartment. A 2-year non-randomised prospective observational cohort study was conducted in unicompartmental knee osteoarthritis patients scheduled for TKR ( n = 431) or UKA ( n = 102). Costs were identified using administrative databases and health outcomes were measured using the SF-36 and the Oxford knee score (OKS) 1 week before, 6 months after, and 2 years after surgery. The incremental cost-utility ratio (ICUR) for TKR versus UKA was calculated and its 95% confidence interval estimated using a nonparametric bootstrapping technique. Cost-effectiveness acceptability curves were constructed from different perspectives. On average, from the societal perspective, the ICUR was US $65,245 per quality-adjusted life-year (QALY). In the scenario with costs calculated from the perspective of patients, the ICUR was $60,382/QALY. This value decreased to $4,860/QALY in the scenario with costs calculated from the governmental perspective. However, the 95% confidence interval of ICURs cannot be defined because more than 5% bootstrapped samples fell into the upper left quadrant of the cost-effectiveness plane from all three perspectives. Based on the 2-year data, TKR gained more QALYs at higher costs compared to UKA. A long-term prospective study is necessary to determine cost-effectiveness of TKR and UKA. [ABSTRACT FROM AUTHOR]

Objectives: To quantify the improvement in health outcomes in patients after total knee replacement (TKR). Methods: This was a two-year non-randomized prospective observational study in knee osteoarthritis (OA) patients undergone TKR. Patients were interviewed one week before, six months after, and two years after surgery using a standardized questionnaire including the SF-36, the Oxford Knee Score (OKS), and the Knee Society Clinical Rating Scale (KSS). A generalized estimating equation (GEE) model was used to estimate the magnitudes of the changes with and without the adjustment of age, ethnicity, BMI, and years with OA. Results: A total of 298 (at baseline), 176 (at six-months), and 111 (at two-years) eligible patients were included in the analyses. All the scores changed significantly over time, with the exception of SF-36 social functioning, vitality, and mental health. With the adjustment of covariates, the magnitude of changes in these scores was similar to those without the adjustment. Conclusions: Both general and knee-specific physical functioning had been significantly improved after TKR, while other health domains have not been substantially improved after the surgery. [ABSTRACT FROM AUTHOR]

Our aim was to cross-culturally validate Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients with knee osteoarthritis (OA) scheduled for total knee replacement in Singapore. Chinese WOMAC was translated from the original English version following standard guidelines. Patients were asked to complete a questionnaire containing the WOMAC (twice within 6 days), the Short Form 36 (SF-36), and the EuroQoL EQ-5D. Reliability was assessed using Cronbach’s alpha and intraclass correlation coefficients (ICC), dimensionality using item-to-domain correlations and factor analyses. Convergent and discriminant construct validity was assessed using six each a priori hypotheses. Chinese WOMAC was well accepted by the patients in the pilot test. The Chinese and English versions were therefore administered to a consecutive sample of 131 Chinese- and 127 English-speaking subjects, respectively, with knee OA. Cronbach’s alpha exceeded 0.7 for all domains except for Chinese pain domain, whereas the ICC exceeded 0.7 for all domains. Hypothesized item-to-domain correlations were observed for all items except for four items in Chinese physical function domain. The factor analyses yielded seven and five factors with eigenvalues of more than 1.0 in the Chinese and English versions, respectively. A total of 10/12 a priori construct validity hypotheses were satisfied for the Chinese version. Weak correlations between WOMAC pain and SF-36 bodily pain and moderate correlation between WOMAC pain and EQ-5D anxiety/depression were observed. Chinese WOMAC was well accepted and demonstrated acceptable psychometric properties in Singaporean patients with severe knee OA. [ABSTRACT FROM AUTHOR]