Cost model and health outcome research unveils cheaper knee surgery alternatives in Australia

A Monash University-led study has shown that structured education and exercise therapy may be cost-effective measures that delay or avoid knee replacement surgery in people with lower pain levels, while improving health care sustainability.

Knee replacement surgery can significantly reduce pain and improve quality of life for people with knee osteoarthritis. But with any good thing, there can be a tendency to overuse treatments beyond what is recommended.

The research team, led by Dr. Sean Docking from the School of Public Health and Preventive Medicine at Monash University, modeled the costs and health outcomes of a national physiotherapy program in comparison to knee replacements, based on Australian clinical registry data and published trial data.

The structured physiotherapy program that the researchers compared was GLA:D Australia, an education and exercise program that can be applied to everyday activities, ensuring participants develop skills to self-manage their osteoarthritis. GLA:D Australia is an implementation project led by co-author Associate Professor Christian Barton from La Trobe University.

“Unlike joint replacement surgery, physiotherapy-led programs are rarely subsidized by the government. Even if someone has private health insurance, there are still costs to access these programs, creating a significant barrier to their uptake,” Dr. Docking said. “This barrier can push people to have surgery before trying other things.”

Their findings, published in JAMA Network Open, suggest that the Australian health care system could save $100 million annually by delaying or avoiding knee replacement surgery in those with lower pain levels.

“Our results suggest that structured education and exercise therapy is cost-effective for the first nine years and also over the lifetime in individuals with low pain levels. Our findings highlight the need for considered approaches that improve the sustainability of care and ensure that the right patient gets the right care at the right time,” Dr. Docking said.

The cost savings are only one way that programs like GLA:D may relieve mounting pressures on the Australian health system. Minimizing joint replacements that are unwarranted can reduce surgery wait lists, with 30 percent of public patients now waiting over a year for a knee replacement.

Co-author Professor Ian Harris, from the School of Clinical Medicine at the UNSW Sydney said one in four knee replacement surgeries in Australia may be unwarranted, and joint replacement surgeries take up more of the health care budget than any other procedure.

“Funding these physiotherapy-led programs would align with the government’s own best practice recommendations and improve the quality of care for knee pain. It could produce significant cost savings for our health system by avoiding unwarranted surgeries and enabling more timely access for those who really need surgery,” Professor Harris said.