A Fresh Perspective on a Familiar Problem: Examining Disparities in Knee Osteoarthritis Using a Markov Model

Med Care. 2017 Dec;55(12):993-1000. doi: 10.1097/MLR.0000000000000816.


Background: Disparities in the presentation of knee osteoarthritis (OA) and in the utilization of treatment across sex, racial, and ethnic groups in the United States are well documented.

Objectives: We used a Markov model to calculate lifetime costs of knee OA treatment. We then used the model results to compute costs of disparities in treatment by race, ethnicity, sex, and socioeconomic status.

Research design: We used the literature to construct a Markov Model of knee OA and publicly available data to create the model parameters and patient populations of interest. An expert panel of physicians, who treated a large number of patients with knee OA, constructed treatment pathways. Direct costs were based on the literature and indirect costs were derived from the Medical Expenditure Panel Survey.

Results: We found that failing to obtain effective treatment increased costs and limited benefits for all groups. Delaying treatment imposed a greater cost across all groups and decreased benefits. Lost income because of lower labor market productivity comprised a substantial proportion of the lifetime costs of knee OA. Population simulations demonstrated that as the diversity of the US population increases, the societal costs of racial and ethnic disparities in treatment utilization for knee OA will increase.

Conclusions: Our results show that disparities in treatment of knee OA are costly. All stakeholders involved in treatment decisions for knee OA patients should consider costs associated with delaying and forgoing treatment, especially for disadvantaged populations. Such decisions may lead to higher costs and worse health outcomes.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arthroplasty, Replacement, Knee / economics*
  • Arthroplasty, Replacement, Knee / statistics & numerical data
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs
  • Health Services Needs and Demand / economics
  • Health Status Disparities
  • Healthcare Disparities / economics*
  • Humans
  • Male
  • Models, Economic*
  • Osteoarthritis, Knee / economics*
  • Osteoarthritis, Knee / epidemiology
  • United States