A claims-based view of health care charges and utilization for commercially insured patients with osteoarthritis

Manag Care. 2009 Dec;18(12):44-50.


Purpose: To evaluate managed care medical and pharmacy claims data from commercially insured patients with osteoarthritis and to examine cost and resource utilization patterns across inpatient care, outpatient care, emergency department, and pharmaceuticals.

Design: Retrospective claims-based analysis.

Methodology: Data were obtained from the PharMetrics/IMS Integrated Patient-Centric Database which contains medical and pharmacy claims for over 60 million Americans. Patients were selected by the presence of one or more Episode Treatment Groups (721* and 722*) associated with joint degeneration and then further segmented by ICD-9 codes (715*) to create a homogeneous group of patients with diagnosed osteoarthritis. Patients were then further stratified into groups for evaluation based on demographics and clinical variables and their effect on cost and utilization patterns. Patients were eligible for inclusion if they fulfilled the ETG and ICD-9 code criteria from Jan. 1, 2007 through Dec. 31, 2007 and possessed 12 months of plan eligibility.

Principal findings: Over 1.1 million patients were included in the analysis. The average age was 54 years, and over 68% of the patients were between ages 36 and 64. Average annual charges associated with osteoarthritis treatment were $5,938, with about 40% from the inpatient environment, 53% from outpatient care, and only 6.3% from pharmaceuticals. The most commonly utilized pharmacotherapies were narcotic analgesics, NSAIDs, and corticosteroids. There was also significant utilization of prescription proton-pump inhibitors and H2 antagonists.

Conclusion: These osteoarthritis-specific, population-based measurements are an exercise in developing data that are easily reproducible in a managed care environment. These data offer a starting point and comparator to further investigate and contrast the charges associated with osteoarthritis and the utilization of ancillary pharmacotherapeutic agents.

MeSH terms

  • Adolescent
  • Adult
  • Fees and Charges / trends*
  • Female
  • Health Services / statistics & numerical data*
  • Humans
  • Insurance Claim Review*
  • Male
  • Middle Aged
  • Osteoarthritis / economics*
  • Retrospective Studies
  • United States
  • Young Adult