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Impact of comorbidities and functional impairment on 5-year loss of health utility in patients with lower-limb osteoarthritis in the KHOALA cohort

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Abstract

Purpose

To examine the respective and combined impact of “hypothetical” functional impairment (FI) and burden of comorbidities accrual on a 5-year risk of health utility (HU) loss in osteoarthritis (OA).

Methods

Participants of the Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) study with a 5-year follow-up were included. FI, number of comorbidities and HU were measured annually by the WOMAC, Functional Comorbidity Index and Short-Form 6D, respectively. We estimated the population risk of HU loss (PRD: population risk difference, PRR: population risk ratio) under hypothetical FI and comorbidities using the parametric G-formula. Then, mediation analysis investigated the causal mechanism of comorbidities on HU through FI by estimating total, direct and indirect effects.

Results

We examined data from 767 patients (68.8% women; 61.6 years). The estimated 5-year risk of HU loss was 47.5% [41.9; 52.2] under natural course and 24.9% [15.5; 34.2] when imposing “Patient acceptable function and No comorbidity” corresponding to a PRD = − 22.6 [− 26.5; − 21.2] and a PRR = 0.5 [0.4; 0.6]. The estimated total risk of HU loss comparing “Two comorbidities” versus “No comorbidity” was significant without mediation effect of FI: Total = 10.1% [6.8; 12.9]; direct = 8.0% [2.7; 13.1]; indirect = 2.1% [− 2.0; 5.2].

Conclusions

FI and comorbidities are important and independent determinants of HU loss in patient with OA. Half of cases (50%) of HU loss during 5 years could be avoided by preventing comorbidities (30%) and limiting FI under patient acceptable function (20%). Caregivers should additionally pay close attention to the prevention and the treatment of comorbidities in routine management of OA.

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References

  1. Lankhorst, N. E., Damen, J., Oei, E. H., Verhaar, J. A. N., Kloppenburg, M., Bierma-Zeinstra, S. M. A., et al. (2017). Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: The cohort hip and cohort knee study. Osteoarthritis and Cartilage, 25(5), 647–653. https://doi.org/10.1016/j.joca.2016.12.006.

    Article  CAS  PubMed  Google Scholar 

  2. Guillemin, F., Rat, A. C., Mazieres, B., Pouchot, J., Fautrel, B., Euller-Ziegler, L., … 3000 Osteoarthritis group. (2011). Prevalence of symptomatic hip and knee osteoarthritis: A two-phase population-based survey. Osteoarthritis and cartilage/OARS, Osteoarthritis Research Society, 19(11), 1314–1322. https://doi.org/10.1016/j.joca.2011.08.004

    Article  CAS  Google Scholar 

  3. Feinstein, A. R. (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases, 23(7), 455–468.

    Article  CAS  Google Scholar 

  4. Sharif, B., Kopec, J., Bansback, N., Rahman, M. M., Flanagan, W. M., Wong, H., … Anis, A. (2015). Projecting the direct cost burden of osteoarthritis in Canada using a microsimulation model. Osteoarthritis and Cartilage, 23(10), 1654–1663. https://doi.org/10.1016/j.joca.2015.05.029

    Article  CAS  Google Scholar 

  5. Sharif, B., Garner, R., Hennessy, D., Sanmartin, C., Flanagan, W. M., & Marshall, D. A. (2017). Productivity costs of work loss associated with osteoarthritis in Canada from 2010 to 2031. Osteoarthritis and Cartilage, 25(2), 249–258. https://doi.org/10.1016/j.joca.2016.09.011.

    Article  CAS  PubMed  Google Scholar 

  6. Salmon, J. H., Rat, A. C., Sellam, J., Michel, M., Eschard, J. P., Guillemin, F., … Fautrel, B. (2016). Economic impact of lower-limb osteoarthritis worldwide: A systematic review of cost-of-illness studies. Osteoarthritis and Cartilage, 24(9), 1500–1508. https://doi.org/10.1016/j.joca.2016.03.012

    Article  CAS  Google Scholar 

  7. Torrance, G. W. (1987). Utility approach to measuring health-related quality of life. Journal of Chronic Diseases, 40(6), 593–603.

    Article  CAS  Google Scholar 

  8. Hosseini, K., Gaujoux-Viala, C., Coste, J., Pouchot, J., Fautrel, B., Rat, A.-C., et al. (2012). Impact of co-morbidities on measuring indirect utility by the Medical outcomes study short form 6D in lower-limb osteoarthritis. Best Practice & Research Clinical Rheumatology, 26(5), 627–635. https://doi.org/10.1016/j.berh.2012.08.007.

    Article  Google Scholar 

  9. Keil, A. P., Edwards, J. K., Richardson, D. B., Naimi, A. I., & Cole, S. R. (2014). The parametric g-formula for time-to-event data: Intuition and a worked example. Epidemiology (Cambridge, Mass), 25(6), 889–897. https://doi.org/10.1097/ede.0000000000000160.

    Article  Google Scholar 

  10. Guillemin, F., Rat, A.-C., Roux, C. H., Fautrel, B., Mazieres, B., Chevalier, X., … KHOALA cohort study. (2012). The KHOALA cohort of knee and hip osteoarthritis in France. Joint, Bone, Spine: Revue Du Rhumatisme, 79(6), 597–603. https://doi.org/10.1016/j.jbspin.2012.03.011

    Article  Google Scholar 

  11. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.

    Article  Google Scholar 

  12. Brazier, J., Usherwood, T., Harper, R., & Thomas, K. (1998). Deriving a preference-based single index from the UK SF-36 health survey. Journal of Clinical Epidemiology, 51(11), 1115–1128.

    Article  CAS  Google Scholar 

  13. Brazier, J., Roberts, J., & Deverill, M. (2002). The estimation of a preference-based measure of health from the SF-36. Journal of Health Economics, 21(2), 271–292.

    Article  Google Scholar 

  14. Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., & Stitt, L. W. (1988). Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. The Journal of Rheumatology, 15(12), 1833–1840.

    CAS  PubMed  Google Scholar 

  15. Faucher, M., Poiraudeau, S., Lefevre-Colau, M. M., Rannou, F., Fermanian, J., & Revel, M. (2004). Assessment of the test-retest reliability and construct validity of a modified WOMAC index in knee osteoarthritis. Joint, Bone, Spine: Revue Du Rhumatisme, 71(2), 121–127. https://doi.org/10.1016/S1297-319X(03)00112-X.

    Article  Google Scholar 

  16. Groll, D. L., To, T., Bombardier, C., & Wright, J. G. (2005). The development of a comorbidity index with physical function as the outcome. Journal of Clinical Epidemiology, 58(6), 595–602. https://doi.org/10.1016/j.jclinepi.2004.10.018.

    Article  PubMed  Google Scholar 

  17. Pham, T., & Tubach, F. (2009). Patient acceptable symptomatic state (PASS). Joint, Bone, Spine: Revue Du Rhumatisme, 76(4), 321–323. https://doi.org/10.1016/j.jbspin.2009.03.008.

    Article  Google Scholar 

  18. Tubach, F., Ravaud, P., Baron, G., Falissard, B., Logeart, I., Bellamy, N., … Dougados, M. (2005). Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: The patient acceptable symptom state. Annals of the Rheumatic Diseases, 64(1), 34–37. https://doi.org/10.1136/ard.2004.023028

    Article  CAS  Google Scholar 

  19. Taubman, S. L., Robins, J. M., Mittleman, M. A., & Hernán, M. A. (2009). Intervening on risk factors for coronary heart disease: An application of the parametric g-formula. International Journal of Epidemiology, 38(6), 1599–1611. https://doi.org/10.1093/ije/dyp192.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lin, S.-H., Young, J. G., Logan, R., & VanderWeele, T. J. (2017). Mediation analysis for a survival outcome with time-varying exposures, mediators, and confounders. Statistics in Medicine, 36(26), 4153–4166. https://doi.org/10.1002/sim.7426.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kuntz, K. M. (2016). Decision modeling for cost-utility analysis. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 19(6), 700–701. https://doi.org/10.1016/j.jval.2016.06.003.

    Article  Google Scholar 

  22. Mo, F., Choi, B. C. K., Li, F. C. K., & Merrick, J. (2004). Using health utility index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals with chronic diseases. TheScientificWorldJournal, 4, 746–757. https://doi.org/10.1100/tsw.2004.128.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Many people worked together selflessly and enthusiastically to make the KHOALA cohort study a success. All the authors of this article warmly acknowledge hospitals and professionals who contributed to the recruitment and follow-up of patients since 2007.

Funding

This work was supported by Centre Hospitalier Régional et Universitaire de Nancy (CPRC 2013: R2016-47). Funding for the KHOALA cohort study was obtained from public sources (INSERM, CHU de Nancy, Conseil Régional de Lorraine, Société Française de Rhumatologie) and unrestricted grants from pharmaceutical companies (Expanscience, Genevrier, Grünenthal, Merck & Co, Inc, Pfizer, Pierre Fabre Médicaments, Sanofi-Aventis France). Opinions expressed in the present article are those of the authors and do not necessarily reflect those of the sponsors. The study sponsors did not take part in study design, collection, analysis and interpretation of data, writing of the report or the decision to submit the article for publication.

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Authors and Affiliations

  1. CHRU-Nancy, INSERM, CIC-Epidémiologie Clinique, Université de Lorraine, Nancy, France

    Abdou Y. Omorou, Hamza Achit & Francis Guillemin

  2. Université de Lorraine, APEMAC, Nancy, France

    Abdou Y. Omorou, Maud Wieczorek, Anne-Christine Rat & Francis Guillemin

  3. Université Paris Descartes, APEMAC, Paris, France

    Jacques Pouchot

  4. UPMC Université Paris 6, GRC-UPMC 08 (EEMOIS), Sorbonne Universités, Paris, France

    Bruno Fautrel

  5. National Clinical Research Platform for Quality of Life in Oncology, France, CHRU de Nancy, Nancy, France

    Abdou Y. Omorou & Francis Guillemin

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  1. Abdou Y. Omorou
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  2. Hamza Achit
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Correspondence to Abdou Y. Omorou.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study received ethics committee approval (CIL no. R 2016-47).

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Informed consent was obtained from all individual participants included in the study.

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Omorou, A.Y., Achit, H., Wieczorek, M. et al. Impact of comorbidities and functional impairment on 5-year loss of health utility in patients with lower-limb osteoarthritis in the KHOALA cohort. Qual Life Res 28, 3047–3054 (2019). https://doi.org/10.1007/s11136-019-02243-4

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