Wednesday, October 22, 2008
Columbus A-C (Hyatt Regency Penns Landing)
Elena Losina, PhD1, Rochelle P. Walensky, MD, MPH2, Holly L. Holt1, William M. Reichmann, MA1, Michael P. Raybman1, Courtenay L. Kessler, MPH1, Daniel H. Solomon, MD, MPH1, Joanne M. Jordan, MD, MPH3, David J. Hunter, PhD, MBBS4, Miriam G. Cisternas, MA5, A. David Paltiel, PhD6 and Jeffrey N. Katz, MD, MS1, (1)Brigham and Women's Hospital, Boston, MA, (2)Massachusetts General Hospital, Boston, MA, (3)University of North Carolina, Chapel Hill, NC, (4)New England Baptist Hospital, Boston, MA, (5)MGC Data Services, Carlsbad, CA, (6)Yale School of Medicine, New Haven, CT
Purpose: The burden of osteoarthritis (OA), one of the top five disabling conditions in the
US, is best measured by its impact on quality of life. Current societal trends demonstrate increasing obesity and OA prevalence. Our objective was to estimate the quality-adjusted life-years lost due to symptomatic knee OA and to examine the impact of obesity on those losses in US patients over age 60 with knee OA.
Methods: We used NHANES III and US Census data to define cohorts of persons >60 y/o (mean age 68 y/o) who have: 1) no knee OA and BMI<30, 2) symptomatic knee OA and BMI<30, and 3) symptomatic knee OA and BMI³30. Per person quality-adjusted life expectancy (QALE) losses for persons with knee OA stratified by obesity (BMI³30), compared to those without knee OA and BMI<30, were estimated using the Osteoarthritis Policy Model (OAPol), a first order Monte Carlo simulation. Model health states were defined by OA severity, comorbidities and obesity. Model input parameters included data on the incidence and prevalence of comorbidities, quality of life decrements associated with symptomatic knee OA obesity and other chronic diseases derived from NHANES III (0.66-0.87). Annual OA progression rates (4%-14%) were estimated from a population-based cohort and calibrated using published literature. Background mortality rates were derived from US life tables.
Results: We estimated that there are 53.3 million persons aged >60 in the US. 8.3 million of them have symptomatic knee OA, of whom 3.1 million are obese. QALE in persons who did not have knee OA and had BMI<30 was 10.57 years. Those with symptomatic knee OA alone had a per person reduction in QALE of 0.61 years, translating into 3,132,402 QALYs lost on a US population basis. QALE in persons with symptomatic knee OA and BMI>30 was decreased by 2.22 QALY per person compared to those without obesity or knee OA, resulting in an additional 6,961,854 QALYs lost.
Conclusions: Ten million QALYs are lost due to knee OA in the US elderly population. The majority of this loss is borne by the minority of persons with knee OA who are also obese. Implementing sustainable obesity control interventions in obese individuals with symptomatic knee OA has the potential to substantially increase the QALE in this population.
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