OAPol: Osteoarthritis Policy Model

In 2006, the Osteoarthritis Policy (OAPol) team, led by Elena Losina at BWH and funded by the National Institute of Health (NIAMS), began building and validating a state-transition Monte Carlo computer simulation model to evaluate the epidemiologic factors that affect knee osteoarthritis (OA), such as obesity and knee injury, the impact the disease has on subjects’ quality of life and lifetime medical costs, and the cost-effectiveness of various knee OA treatments.

The model tracks every individual’s clinical course from the time of entry into the model to death, incorporating comorbidities, such as cancer, coronary heart disease, and other musculoskeletal diseases, and traumatic knee injuries, such as anterior cruciate ligament and meniscal tears. The model then outputs population-level data including our primary outcome measures: average quality-adjusted life expectancy and lifetime medical costs.

We work with a scientific advisory board of expert clinicians, epidemiologists, and modelers, both nationally and internationally, to validate and refine our modeling approach and our derivation of data as input parameters for the model.

For further information, please see our grant abstract.

OAPol: Latest News

Publications in Osteoarthritis & Cartilage – December 2015
“Model-based evaluation of cost-effectiveness of nerve growth Factor inhibitors in knee osteoarthritis: Impact of drug cost, toxicity, and means of administration” is an original research article examining the cost and toxicity thresholds under which a nerve growth factor inhibitor (NGF-i) would be a cost-effective treatment for knee OA patients. Given the high cost of drug administration in a hospital setting, we found that these agents are not cost-effective if they require intravenous hospital administration. However, if administration of the drug occurs at home and they are proven to have minimal effect on NGF-is could be a cost-effective treatment option.

Publications in Osteoarthritis & Cartilage – November 2015
“Cost-effectiveness of nonsteroidal anti-inflammatory drugs and opioids in the treatment of knee osteoarthritis in older patients with multiple comorbidities” was recently accepted at Osteoarthritis & Cartilage. In this manuscript, we used the OAPol Model to evaluate the long-term clinical and economic implications of using nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids in the treatment of knee OA patients who have multiple comorbid conditions, thereby increasing their risks for adverse events on both classes of analgesics. We found that, in this patient population, opioids lead to higher costs and reduced quality of life when compared to NSAIDs. In patients presenting with multiple comorbidities, naproxen- and ibuprofen-containing treatments are more effective in managing OA pain.

Publications in Osteoarthritis & Cartilage – November 2015
“Risk and risk perception of knee osteoarthritis in the US: a population-based study” was recently accepted at Osteoarthritis & Cartilage. In this report, we present the results of using Amazon’s Mechanical Turk to recruit a sample of younger American adults without knee osteoarthritis (OA) and evaluating their perceived risk versus their actual risk of developing knee OA, which was calculated from an online risk calculator (OA Risk C) developed from and validated by the OAPol Model. We found that, in this population of younger adults, risk factors for knee OA are prevalent. Participants consistently overestimated their lifetime risk and showed even greater overestimation of their 10-year risk of knee OA. These data offer insight into the awareness of younger individuals at risk for knee OA and suggest directions for education and risk intervention efforts.

Publications in BMC Musculoskeletal Disorders – October 2015
“Development and feasibility of a personalized, interactive risk calculator for knee osteoarthritis” is an original research article describing the design of a personalized osteoarthritis risk calculator and the ease and feasibility of its use. We used the OAPol Model to generate knee OA risk estimates for individuals of various demographic and clinical characteristic and subsequently developed a computer-based risk calculator. The calculator is easy to use and can be utilized to provide individualized risk estimates and to deliver educational interventions focused on OA risk reduction.

Publications in PLoS One – June 2015
“Defining the value of future research to identify the preferred treatment of meniscal tear in the presence of knee osteoarthritis” is an original research article examining the long term clinical and economic outcomes of alternative treatment strategies for patients with concomitant mensical tear and knee osteoarthritis. We found that physical therapy alone is unlikely to be a cost-effective strategy and that, despite recent trials failing to show superiority of arthroscopic partial meniscetomy (APM), the current data do no support the rejection APM on a cost-effectiveness basis.

Publications in Arthritis Care & Research – February 2015
“Lifetime medical costs of knee osteoarthritis management in the United States: impact of extending indications for total knee arthroplasty” is an original research article examining lifetime medical costs and TKA utilization under a range of eligibility criteria.  Using the OAPol Model, we found that medical costs attributable to knee OA are minor; however, this cost substantially increases as the eligibility for TKA expands.