OBJECTIVES: The Public Health Agency of Canada reports ~3.6M Canadians (2010 population: 33.7M), are living with any type of osteoarthritis (OA). Quality of life is greatly impacted among patients with moderate-to-severe OA; therefore, capturing the burden of disease in Canada is important for planning novel treatment strategies. To identify real-world evidence (RWE) on the clinical and economic burden of moderate-to-severe OA in Canada via systematic literature review.

METHODS: Search strategies were executed in MEDLINE, Embase, the Cochrane Library, and selected conferences to identify citations published between Jan 2013 and Nov 2018. Selection criteria included Canadian populations with clinically or radiologically confirmed moderate-to-severe OA, defined by author. Outcomes included: prevalence, clinical or economic measures and treatments. This review was conducted and reported in-line with the PRISMA statement.

RESULTS: 1881 citations were screened and 19 Canadian RWE studies were included. Prevalence rates were not reported. One microsimulation model estimated that 649K Canadians visited an orthopaedic surgeon for total joint replacement evaluation/surgery. Study populations were predominately female (44-83%) and 57-74 years old. Only 7 studies captured joint characteristics of individuals with moderate-to-severe OA of the hip or knee; only 6 studies reported pain scores. The main findings included an average of 3-6 symptomatic joints (3 studies); hypertension as the most common comorbidity (61-68%; 2 studies), and NSAIDs as the most frequent treatment (2 studies). Opioid use was not consistently reported (3 studies). The estimated average annual cost of OA per person increased with disease severity ($468 to $3,185; 2017 $CAD), with the highest costs for moderate-to-severe, driven by joint replacement.

CONCLUSIONS: Burden of moderate-to-severe OA in Canada is significant; however, inequities in recent/standardized definitions and reporting highlight an important gap in prevention and treatment strategies. Despite limited data, progressing disease and worsening disability leads to poor patient-outcomes and increased healthcare costs.