The Future, page-78

Just came across this interesting analysis, was published a fair while ago by Lodge Partners but all still relevant and hopefully throws some colour onto what we are discussing and the perspective from the insurance companies. TKA is Total Knee Arthroplastie.

It is estimated that one in two Americans will have painful knee OA in their lifetime (ArthritisRheum. 2008 Sep 15;59 (9):1207-13). The socioeconomic impact of this is considerable. In2004, USD14b in hospital charges alone were attributed to the disease in the US(http://www.hcup-us.ahrq.gov/nisoverview.jsp).In 2008, there were more than 600,000 TKA’s conducted in the US (Arthritis Rheum. 2008Sep 15;59(9):1207-13), with each TKA costing approximately USD50k. When these numbersare multiplied, approximately USD30b are spent each year on TKAs in the US.When one factors in that approximately 75% of knee OA cases are associated with BME(Ann Intern Med. 2001 Apr 3;134(7):541-9), USD22.5b in healthcare costs could ultimatelylead back to BME through TKAs alone. These figures would be even higher if the markets forOA associated with other joints and/or for painful BME not associated with OA are included.Insurance companies will be willing to pay handsomely for a product that can even marginallyreduce these costs. Prevention of major surgery is a strong.

Reference : http://paradigmbiopharma.com/wp-content/uploads/2016/03/2015-11-30-Initiating-Coverage-Paradigm-Biopharma-Lodge-Partners-Final.pdf