Cost consequences of physiotherapy and orthopaedic referral pathways for knee and hip osteoarthritis in Greenland: a pragmatic decision-analytic study.

backgroundKnee and hip osteoarthritis (OA) are common chronic conditions associated with pain, functional limitations, and reduced quality of life. OA constitutes a substantial burden on healthcare systems worldwide, with arthroplasty procedures accounting for a large share of OA-related costs. In Greenland, access to orthopaedic surgery is constrained by long waiting times, geographical dispersion, and limited specialist capacity, highlighting the need to understand the cost consequences of alternative referral pathways in routine care.

methodsWe conducted an exploratory, pragmatic cost analysis using a decision tree model to examine the cost consequences of two referral pathways for knee and hip OA in routine clinical practice in Greenland: referral to orthopaedic surgical assessment and referral to a physiotherapist-delivered exercise therapy programme. The study population comprised individuals newly diagnosed with knee or hip osteoarthritis referred in Nuuk between 2021 and 2022. From a societal perspective, healthcare system costs and productivity loss costs were included over a two-year time horizon, with costs reported in Euros (€). Sensitivity analyses explored alternative assumptions regarding surgical uptake over an extended four-year period.

resultsOver the initial two-year period, total societal costs per patient were €20,504 for the orthopaedic referral pathway and €2,442 for the exercise therapy referral pathway. Hospital-related costs amounted to €16,821 per patient in the orthopaedic pathway and €1,176 per patient in the exercise therapy pathway, while productivity loss costs were €3,683 and €666 per patient, respectively. In sensitivity analyses extending to four years, the exercise therapy referral pathway remained associated with lower hospital-related costs than the orthopaedic referral pathway under a range of assumptions regarding subsequent arthroplasty.

conclusionsUnder the assumptions applied, referral to a physiotherapist-delivered exercise therapy programme was associated with lower hospital-related costs than referral to orthopaedic surgical assessment in routine care for knee and hip osteoarthritis in Greenland. These findings highlight how the organisation of referral pathways within the healthcare system may influence resource use in settings with constrained surgical capacity. Further research integrating clinical outcomes with economic evaluation is needed before drawing conclusions regarding optimal treatment strategies.