Ongoing Research
In 2006, the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS) awarded our group a grant to: develop a computer-simulation model of the natural history and management of knee OA and use the model to conduct policy evaluations on the value and design of specific knee OA treatment and monitoring strategies. Since then, we built and validated the OAPol Model and produced peer-reviewed publications andabstracts. Additional manuscripts are under review or in preparation.
Below you will find brief descriptions of several of our exciting ongoing projects. To learn more about our past, published research projects, please refer to the Published Research page.
ACL Tears
Anterior cruciate ligament (ACL) injuries are increasingly common in the US; however, the utilization of reconstruction has not been examined rigorously. Using data from a tertiary health care system patient data repository, we estimated that the 3-year cumulative incidence of ACL reconstruction surgery among patients with diagnosed ACL tear was 22.6%. Among those undergoing reconstruction, 86% did so within 6 months. We found that the odds of undergoing surgery were higher among: males, whites, patients of high socio-economic status, young patients, and patients with private health insurance.
APM Cost-Effectiveness Analysis:
We sought to evaluate the clinical and economic value of arthroscopic partial meniscectomy (APM) when compared with a regimen of physical therapy followed by APM and a regimen of physical therapy alone for the treatment of meniscal tear in adults with osteoarthritis. Because both meniscal tear and APM are prevalent and play a role in osteoarthritis progression, the results of our work will contribute a much-needed economic dimension to the overall goal of informing patients and physicians in the shared-decision making process following a diagnosis of meniscal tear.
DMOADs Prevention:
Disease-modifying osteoarthritis drugs (DMOADs) are currently under investigation in clinical trials as potential methods of halting the structural progression of OA. We sought to evaluate the cost-effectiveness of DMOADs when used as a prophylaxis. By examining the clinical and economic value of DMOADs in cohorts possessing varying risks for the development of OA, this project evaluates for whom and under what conditions the use of DMOADs may be maximally cost-effective as method for OA prevention.
Lifetime Costs
As the only currently available effective treatment for knee osteoarthritis (OA), total knee arthroplasty (TKA) has seen a dramatic expansion in uptake to match the growing number of patients suffering from knee OA. Despite this, the impact of greater TKA utilization on lifetime medical costs has not been studied. We therefore seek to estimate the lifetime medical costs of knee OA patients, the proportion of these costs directly attributable to knee OA management, and the effect on costs of changing indications for TKA.
Opioid Utilization
As effective pain management has become critical to the treatment of osteoarthritis over the past several decades, pharmacotherapy regimens have changed and evolved. In the past 10 years or so, awareness of potential adverse effects due to NSAID use has grown while simultaneously more and more care guidelines consider the use of opioids in treating pain. For this study, we are examining how prescription NSAID and opioid use has changed over the past decade using data from MCBS 2003, 2006, and 2009 to see if there are any trends in utilization.
Impact of Knee Injuries on OA Development
Anterior cruciate ligament (ACL) and meniscal injuries are increasingly common in the US, particularly among young adults, and are considered potent risk factors for OA development. The increasing prevalence of these injuries creates concerns regarding their long-term effects on knee OA development and future societal impact. Using the OAPol Model, we aim to quantify the lifetime risk of knee OA and total knee replacement (TKR) in persons sustaining ACL and meniscal injuries in early adulthood.
Calculating Risk of OA and TKR:
Risk calculators have commonly been used to provide patients with information about their risk of heart disease and cancer based on demographics and risk factors. Currently, no risk calculator exists for knee OA. Using the data from the OAPol model, we have developed an application that will allow patients to see estimates for their risk of developing knee OA and requiring a TKR over various time-spans. We are currently studying the effects of personalized risk estimates provided from the risk calculator on individuals’ willingness to change modifiable risk factors for OA. In the future, we aim to create an online platform for the risk calculator so that it can be used by the general public as an educational tool.
Long-Term Cost-Effectiveness of Opioids:
Standard treatments for knee OA beginning with acetaminophen and nonsteroidal anti-inflammatory drugs are relatively safe, but are often insufficient in long-term pain relief. The addition of stronger analgesics, such as opioids, are accompanied by trade-offs between increased efficacy, higher toxicity, the need for more frequent monitoring, risks of illicit use, and possibility of poorer total knee replacement outcomes. We seek to understand the clinical and economic implications of incorporating opioids into the treatment sequence for knee OA patients.
Weight Loss Regimens for OA Management:
Recent evidence suggests that weight loss through diet and exercise may help to reduce pain and improve function in patients with osteoarthritis (OA). In response to these new developments, we aim to incorporate weight loss into our model’s OA treatment regimens. This will allow us to extend the results of current research and to estimate the large-scale benefits and cost-effectiveness of weight loss as a treatment for OA.
Cost-Effectiveness of Generic Celecoxib
Both nonselective (ns)- and selective-nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesics for the treatment of knee OA. While ns-NSAIDs are widely available in generic form, the generic formulation of the COX-2 selective NSAID celecoxib was only recently approved by the FDA. As generic formulations are less expensive than their brand-name counterparts, we aim to evaluate the cost-effectiveness of generic celecoxib. In doing so, we seek to provide thresholds of toxicity, efficacy, and costs under which generic celecoxib would be considered a cost-effective option for knee OA pain management.
Impact of Racial Disparities in Total Knee Arthroplasty
A body of scientific literature has focused on examining trends between different racial and ethnic populations to identify potential disparities between these groups in the treatment of knee OA, particularly regarding the receipt and experience of total knee arthroplasty. Using data from this literature in combination with the OAPol Model, we seek to estimate the quality of life-related impacts of these disparities on minority populations.