Abstract No. 578 Peri-procedural Out-of-Pocket Costs of Nonoperative Interventions and Services for Knee Osteoarthritis

The following study evaluates comparative nonoperative maintenance costs for the management of knee osteoarthritis (OA) before and after genicular nerve ablation (GNA), arthroscopy, osteotomy, total knee arthroplasty (TKA), and unilateral knee arthroplasty (UKA). Outpatient diagnoses of knee OA were queried in 2016-2021 using ICD-10 codes in the Merative MarketScan Database and were categorized into five procedural groups according to respective procedural codes including GNA, knee arthroscopy, knee osteotomy, TKA, and UKA. The difference between pre- and post-procedure out-of-pocket (OOP) costs one year before and after each procedure were compared for nonoperative maintenance costs such as physical therapy, bracing, intra-articular injections of hyaluronic acid (IA-HA) and corticosteroids (IA-CS), professional injection administration fees (PIAF), and knee imaging (Table 578.1). Costs were adjusted using the Consumer Price Inflation Index to the April 2023 US dollar value and then compared using Welch's t-test. GNA, osteotomy, TKA, and UKA significantly decreased OOP costs related to nonoperative maintenance of knee OA. Significant decreases in OOP costs for patients who underwent GNA involve IA-HA, professional fees for injection, and related imaging. Significant decreases in OOP costs for osteotomy, TKA, and UKA groups are related to IA-CS, professional fees for injection, and related imaging. However, TKA and UKA both contributed to a statistically significant increase in post-OOP costs from an increased need for PT. GNA has cost-saving implications that allow for as much as a 30% decrease in periprocedural costs due to decreases in utilization of IA-HA injections and imaging Compared to TKA and UKA, GNA does not increase the costs associated with increased need for PT after surgery.