OMT - Economics & Employer Impact

Osteoarthritis Management Toolkit

Building the Business Case: Economics & Employer Impact

According to a recent study, the prevalence of arthritis in the US is likely underestimated, especially in adults under age 65. The current estimate of 54 million is focused on doctor-diagnosed arthritis. This leaves a large portion of people suffering from joint pain related to undiagnosed arthritis unaccounted for. When researchers adjusted the current estimate to include this group, the reported national estimate of arthritis prevalence increased by 68%. 

The related economic impact of osteoarthritis on employers can be substantial, effecting health care, productivity and disability costs. Unfortunately, this condition does not hit the radar of most employers who are focused on top cost drivers such as diabetes and cancer. 

Calculating the direct and indirect costs related to osteoarthritis will likely entail untangling the condition from other chronic conditions. The majority of people with OA have at least one other chronic condition, most commonly cardiovascular disease, diabetes and hypertension.

Productivity

Much of the discussion around osteoarthritis and productivity is about pain, which is the primary symptom of the condition. Pain associated with OA has a significant impact on mobility and function. People with OA struggle daily with pain that also impacts their emotional and social functioning. Reported “pain days” are associated with increases in both absenteeism and presenteeism in the workplace.

Lost productivity, whether in the form of presenteeism (reduced productivity while at work) or absenteeism (missed time from work), is a major source of the economic burden of osteoarthritis for employers. Research has shown that individuals in the workforce with moderate and severe osteoarthritis had significantly more work impairment than their counterparts without OA. (EPIC p. 7)

 

Individuals with OA spent 30% less time in productive work, and their presenteeism-related lost productivity accounted for three to four times as many lost hours as absenteeism. (EPIC p. 7)

In the US, osteoarthritis is responsible for an aggregate absenteeism cost of $10 billion annually, the equivalent to approximately three lost workdays per worker with OA. Costs associated with presenteeism were much more varied ranging from $700 - $7,000 per employee per year.  (OARSI p. 37)



Utilization of Health Services

Osteoarthritis is a complex, chronic condition with no cure. Treatment is ongoing and is typically a combination of pharmacological and non-pharmacological options, with varied results depending on the individual. For these reasons, OA is associated with increased use of health services and related costs. According to the Osteoarthritis Action Alliance (OAAA), health care expenditures for arthritis-related conditions doubled from 1996 to 2014, and the per-person medical costs attributed specifically to OA averaged $11,052 per-year between 2008 to 2014.

Snapshot: Knee Osteoarthritis

According to the Arthritis Foundation, annual incidence of knee osteoarthritis is highest in people between age 55 – 64. Knee OA has increased steadily over the years, in sync with the number of aging baby boomers and the obesity epidemic. 

Two-thirds of adults with obesity will develop knee osteoarthritis in their lifetime and body mass index is a strong predictor for progression of the disease.


As the number of people with knee OA goes up, so does the rate of related surgical procedures to treat the condition. According to a
recent study published in the BMJ, the annual rate of total knee replacements in the US has doubled since 2000 and is expected to rise 189% by 2030. The research showed that this is especially true among those age 45 – 64 and is mainly attributed to the expansion of eligibility to people with less severe symptoms. The study concluded that total knee replacement had limited effect on this population. The researchers stated that the procedure could be considered cost effective if it were restricted to individuals with severe knee OA and poor functioning prior to surgery.

A 2018 study conducted by the American Academy of Orthopaedic Surgeons reports that total joint replacement, including that associated with knee OA, is one of the most common elective surgeries performed in the US today. They also found that this type of procedure is clinically effective and cost effective in individuals with end-stage arthritis. 

As these studies point out, the number of unnecessary, ineffective total knee replacement surgeries is expected to continue with significant growth. It is important to note that joint replacement doesn’t cure or reverse osteoarthritis, although it lessens the severity of the disease and can provide improvements in pain and physical function in some patients. Because many individuals with knee OA are in the workforce, employers need to consider the costs associated with unnecessary procedures in this area and the importance of educating the workforce about the realities of the procedures to set appropriate expectations related to outcomes.