How to cut the $23 billion bill for osteoarthritis

Experts are calling on the government to reduce the $23 billion a year bill for the direct and indirect costs of osteoarthritis (OA) by implementing a new national strategy developed by University of Sydney researchers.

Osteoarthritis is the most common chronic joint disease in Australia and one of the leading causes of pain, disability and early retirement. It affects more than 2.2 million people in Australia, and the majority of people living with OA are 25-64 years old.  Half of the $3.75 billion spent yearly on OA is from joint replacements alone.

With an ageing and increasingly obese population, the prevalence of osteoarthritis in Australia is projected to soar. The consequences for the economy, work productivity, health services and population health will be immense.

The National Osteoarthritis Strategy, prepared by the National Osteoarthritis Project Group, aims to provide a national response to OA and to deliver major benefits to people at risk of, or with, osteoarthritis by making more effective, cost-effective and accessible healthcare solutions available.  The strategy will be presented this week at the 2018 Osteoarthritis Summit in Canberra.

World-leading osteoarthritis expert Professor David Hunter from the University of Sydney, who led the strategy, said that this Australia-first plan focuses on prevention of OA through reducing obesity and increasing physical activity; increasing non-surgical care; increasing support for self-management of OA, and with joint-replacement surgery only a last resort.

“Osteoarthritis has an immense impact on people’s physical and mental health, our health system and the productivity of Australian workers,” said Professor Hunter, who is the Florance and Cope chair of Rheumatology at Royal North Shore Hospital and Musculoskeletal Stream Lead for Sydney Health Partners.

“Despite the tremendous burden this disease places on individuals, families, healthcare systems and society, the care that consumers receive is often fragmented and inappropriate.

“The Strategy identifies seven priority areas covering the whole person journey from prevention and early management to joint replacement or other surgery and rehabilitation, focusing on reducing the impact of osteoarthritis on individuals, families and the community.

“To curb the exponential burden of osteoarthritis, effective prevention and management and cost-effective health services are required - a lot of cases of OA can be prevented.”

The total economic cost of osteoarthritis, including indirect costs such as lost work productivity and loss of wellbeing, is estimated to be over $23 billion each year. It is projected that the number of cases of osteoarthritis will increase to 3.0 million people by 2032 and the prevalence will increase by 41 per cent in the coming decades.

“We’re calling on the government to implement this strategy. It could save in excess of $3 billion of expenditure per year, not to mention prevent much pain and suffering,” said Professor Hunter.

“From an economic perspective, we have demonstrated in New South Wales that for every dollar invested in these types of programs the health system can save around five dollars from joint replacement costs. 

“Nearly 100,000 Australians had joint replacements to treat OA in 2016 at an estimated cost of $2 billion. There’s been a 30 percent increase in the number of knee replacements in the last ten years and this could continue to rise. Many of these surgeries could have been prevented through weight management and increased physical activity.

“This strategy focuses on targeting appropriate patients and providing them with appropriate multidisciplinary care. It’s not complicated. To most people it is just common sense and ultimately if the government refuses to listen, the tsunami of joint replacements will continue to escalate.”

The Strategy includes community-level targets such as increasing physical activity levels by 15 percent by 2030 and reducing sports-related knee injuries by 25 percent by 2025 to help prevent osteoarthritis. It also calls for at least 50 percent of people with osteoarthritis to be undertaking lifestyle and other self-management strategies to reduce pain and disability by 2025.

The Strategy calls for both Medicare and health insurance reform to provide adequate multidisciplinary support for issues such as weight loss and pain management.

Osteoarthritis fast facts

• OA cost the health system $3.75 billion in 2012
• OA is the most common chronic joint disease in Australia
• 1 in 8 Australians are affected by OA
• 38 percent rise in the rate of total knee replacements for OA from 2005-06 to 2015-16. Nearly 100,000 Australians had joint replacements to treat OA at an estimated cost of $2 billion in 2016
• Osteoarthritis is a leading cause of early retirement
• 1 in 6 Australians with OA reported high or very high psychological distress, over 5 times higher compared to those without the condition.
• 2 in 3 people who have OA are female
• More than 1 in 2 Australians with OA report moderate to very severe pain
• Half of people with OA aged between 45 and 64 years are currently not in the workforce, twice as many as those without the condition
• A loss of $7.2 billion in GDP was estimated for 2015 due to the impact of arthritis on the labour force and the total economic cost of arthritis, including indirect costs such as lost work productivity and loss of wellbeing, is estimated to be over $23 billion each year
• Osteoarthritis (OA) is a common type of arthritis that occurs when the joint tissues are damaged, and is associated with joint pain and stiffness, reduced mobility and reduced quality of life.

About the National Osteoarthritis Strategy

The National Osteoarthritis Strategy has been developed to align with current Guidelines, Standards and jurisdictional Models of Care. It takes into account new evidence and feedback received from broad consultation both in Australia and internationally.

The Strategy is endorsed by Arthritis Australia, the Australian Rheumatology Association, the Australian Orthopaedic Association and the Australasian College of Sport and Exercise Physicians, with additional discussions with other organisations ongoing. Medibank Better Health Foundation and Australian Orthopaedic Association provided financial support.