The Value of Decision Aids in Rheumatoid Arthritis: Reduced Procedures, Costs

VBCR - September 2012, Volume 1, No 4 - Value Propositions

A new report from the Group Health Cooperative in Seattle, WA, highlights the benefits in providing decision aids for patients with knee or hip rheumatoid arthritis (RA) by significantly reducing the rates of surgery for knee or hip replacement surgery. In their study, knee replacement surgery was reduced by 38%, resulting in 21% cost reductions over a 6-month period; similarly, hip replacement surgery was reduced by 26%, leading to 12% lower costs over 6 months.

Joint replacement is a common procedure in the United States, amounting to more than 650,000 knee replacements and 250,000 hip replacements annually, at a combined annual cost of $15.6 billion.

This is the first study to demonstrate the value of decision aids as a clinical and economic tool to affect patient clinical decision-making and associated costs in rheumatic conditions. “Decision aids are balanced sources of information that clearly present the evidence-based pros and cons of treatment options for a health condition,” said lead investigator David E. Arterburn, MD, MPH, a general internist and associate investigator at Group Health Research Institute. These results are consistent with previous studies with other types of decision aids, which show that patients are likely to make conservative, less-invasive treatment decisions when presented with evidence-based information about the risks and benefits of different treatment options.

The decision aids provide clear information to patients, such as the 3-month recovery time from a knee or hip replacement surgery, the risk for infections, and the limited (10- to 20-year) duration of the artificial joint. This information is presented by a video that is sent to the patient or online on Group Health’s website. 

This approach is further enhanced by the way providers at the Group Health Cooperative in Seattle are being paid; they receive a salary rather than applying the fee-for-service methodology common in many practices. By having no incentives to do more procedures, which are often tied to a provider’s bonus and are usually quite costly, they can focus on helping
the patients to reach a decision based on true clinical benefits that is also appropriate for their economic situation. Applying decision aids to the treatment paradigm of patients with RA can help to reduce the costs
associated with this condition, while improving patient satisfaction. Health Affairs; September 2012

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