# Optimizing the value of pain management in knee OA patients with comorbidities

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2024 · $790,316

## Abstract

The broad objective guiding our research is to conduct analyses that will inform health care providers and
policy makers on how to deliver equitable, value-based care for patients with knee OA, particularly those who
experience challenges related to social determinants of health (SDoH).
Symptomatic knee OA is a prevalent, disabling and costly disease that affects over 14 million Americans and
accounts for $27 billion/year in healthcare expenditure. The SDoH have been shown to contribute to worse
outcomes of knee OA, and these challenges are further exacerbated by the gap between ‘what we know’ and
‘what we do’. Strong evidence suggests that exercise is efficacious for pain control, but adequate
implementation of exercise programs is hindered by a lack of funds and infrastructure. Telemedicine (TM),
potentially a paradigm-shifting tool in many facets of OA management, improves convenience, but its adoption
depends on patient’s digital literacy, and requires careful consideration of how to integrate it in the continuum
of OA care. The armamentarium of intraarticular injections is growing rapidly, but concerns regarding efficacy,
lack of standardization, and high cost raise concerns among providers, while aggressive advertising campaigns
lead to increased demand for these injections from patients with knee OA. In 2018, the Centers for Medicare &
Medicaid Services moved total knee arthroplasty (TKA) off the inpatient-only list, opening opportunities for
outpatient/ambulatory TKA delivery. This shift presented potential economic savings for payers but raised
questions about patient selection and its impact on patients with knee OA living in rural areas and for patients
with less social support.
We propose to enhance the capabilities of the Osteoarthritis Policy (OAPol) Model to examine the value of
prioritizing knee OA management strategies based on their potential to reduce inequities in health care
delivery and outcomes. We focus on three major aspects of OA management with sizeable gaps between
evidence and current practice: 1) optimizing the value of TM-based OA management and promoting its use
among persons with challenges related to SDoH; 2) establishing the value of alternative intraarticular
injections with various formulations and reducing inequities in uptake; 3) assessing the value of
outpatient/ambulatory TKA and comparing resulting health gains to impacts on disparities. We propose to use
innovative modeling methods to assess the value of TM, orthobiologics and outpatient TKA and to identify
strategies to reduce inequities in the delivery of these treatments in persons with SDoH-related challenges.
This study will guide clinicians in optimizing their efforts to promote care that is cost-effective and equitable.

## Key facts

- **NIH application ID:** 10875824
- **Project number:** 2R01AR074290-06A1
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Elena Losina
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $790,316
- **Award type:** 2
- **Project period:** 2018-08-01 → 2029-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10875824

## Citation

> US National Institutes of Health, RePORTER application 10875824, Optimizing the value of pain management in knee OA patients with comorbidities (2R01AR074290-06A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10875824. Licensed CC0.

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