David Hunter MBBS, PhD, FRACP Florance and Cope Chair of Rheumatology, Professor of Medicine University of Sydney and Royal North Shore Hospital Chair, Institute of Bone and Joint Research Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine

1. David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
David.Hunter@sydney.edu.au
@ProfDavidHunter

2. I declare that in the past two years I have:
• Consulted for Pfizer, Zynerba, TLCBio, Kolon Tissuegene, Merck
Serono
• Supported by an NHMRC Health Practitioner Fellowship.

3. • The individual and socioeconomic impact of osteoarthritis. Hunter DJ,
Schofield D, Callander E. Nat Rev Rheumatol. 2014 Jul;10(7):437-41.
• Osteoarthritis: A Serious Disease, Submitted to the U.S. Food and Drug
Administration December 1, 2016.
https://www.oarsi.org/sites/default/files/docs/2016/oarsi_white_paper_oa_seri
ous_disease_121416_1.pdf
• Therapy: Are you managing osteoarthritis appropriately? Nat Rev Rheumatol.
2017 Dec;13(12):703-704.
• Lower extremity osteoarthritis: optimising musculoskeletal health is a growing
global concern: a narrative review. Br J Sports Med. 2018 Jul 20.
• 2018 Royal Australasian College of GPs Guidelines:
https://www.racgp.org.au/your-
practice/guidelines/musculoskeletal/hipandkneeosteoarthritis/

5. Hunter DJ. NEJM. 2015;372:1040-1047.

7. Hunter DJ et al. Nature Reviews
Rheum. 2014 Jul;10(7):437-41.
The individual and
socioeconomic impact of
osteoarthritis.
Two in three patients the last
time they were pain free was over
a year ago.
Two-thirds of those affected are
of working age leading to
premature retirement.
One in three GPs considers
osteoarthritis a very challenging
condition to treat
Costs ~0.5% of GDP in most
developed countries

8. Hunter, DJ et al. Nat Rev Rheumatol. 2014 Jul;10(7):437-41
Non-pharmacologic
treatment
Pharmacologic treatment
Surgery
Side effects from treatment
Long-term care
Health care providers
Absenteeism
Reduced
employment
Reduced productivity
Caregiver time
Premature mortality
Pain
Activity limitation
Decreased quality
of life
Fatigue
Reduced social
participation

9. in 2015 increase since
2000
per patient per
year (2015 data)
Arthritis Australia 2016,
Arthritis and Osteoporosis Victoria 2013
of the total cost of
musculoskeletal
conditions
1 – Why Invest in OA Research?

10. Hospital inpatient Aged care
Pharmaceutical Out of hospital medical services
Out-patient Other professional services
Research
1 – Why Invest in OA Research?

11. 2 – Financial simulations of various interventions
Scenario 3
Interventions Average
cost per
patient
Estimated
reductions in
interventions
Net savings to the
health system
annually (in
millions)*
Knee
replacements
$20,000 2,318 $46
Knee
arthroscopies
$5,000 6,000 $30
ACL
reconstruction
$6,223 3,616 $23
TOTAL
* This doesn’t take into account the increase of productivity
• Sport joint injury is one of the
leading causes of OA
• Programs as simple as warm-up,
balance, stretching, strengthening,
plyometrics, and sport specific agility
training have shown their efficacy
and can reduce the risk of joint injury
as much as 60%
• Implementation of a modestly
effective injury prevention program
that reduces the knee injury rate by
30%
• The program can be feasibly
implemented by leveraging existing
resources
• Compared to the annual cost of
doing nothing the implementation is
substantially cheaper
CONTEXTSCENARIO3

12. 3 – Making OA research happen
2015-2016 2016-2017
Rheumatoid arthritis $3.37 $0.32
Osteoporosis $3.43 $2.31
Osteoarthritis $6.19 $6.43
Lupus $2.09 $2.18
Chronic Back $2.17 $3.07
Rheumatic Fever
/Heart Disease
$0.78 $0.25
TOTAL $18 $14.56
NHMRC funding for all arthritis (millions)

13. 3 – Making OA research happen
2.1 million Australians 1.2 million Australians
Leading cause of disability Chronic disease
3.7 billion direct costs annually
(5% of annual federal budget)
1 billion direct costs annually (1%
of annual federal budget)
30 billion total (direct+ indirect
costs) annually
6 billion total (direct+ indirect
costs) annually
$6 million research funding $64.1 million research funding
0.7% of NHMRC funding 7.7% of NHMRC funding
Source: AIHW, 2016
Health expenditure on chronic diseases, by area of
expenditure, 2008-2009

16. https://www.racgp.org.au/your-practice/guidelines/musculoskeletal/hipandkneeosteoarthritis/
Nat Rev Rheumatol. 2017 Dec;13(12):703-704

19. To outline Australia’s national response to osteoarthritis and inform
how existing limited healthcare resources can be better coordinated
and targeted to achieve optimal outcomes for people.
• Guide the development, planning and implementation of osteoarthritis
prevention and management through research, healthcare professionals and
community education and best practice clinical services using a whole of
population approach.
• Support the delivery of consistent, evidence-based strategy, to manage and
minimise the impact and extent of osteoarthritis in the Australian community.
• Achieve agreement for a national implementation program to deliver the
models of best-practice treatment and self-management of osteoarthritis.
• Make best-practice osteoarthritis management accessible to all Australians.

21. Prof. David Hunter
(Chair)
Florance and Cope Chair of Rheumatology, Chair of Institute of Bone and Joint Research, Northern Clinical
School, University of Sydney and Royal North Shore Hospital
Ms. Franca Marine National Policy and Government Relations Manager, Arthritis Australia
Ms. Katharine Silk Integration and Innovation Manager of the Australian Healthcare and Hospitals Association
Dr. Norman Swan Broadcaster and presenter of the ABC Radio's Health Report; Executive Director Tonic Health Media
Ms. Sonia Dixon Head of Better Health Foundation, Medibank Private
Prof. Lyn March Liggins Professor of Rheumatology and Musculoskeletal Epidemiology, Northern Clinical School, University of
Sydney; the Australian Rheumatology Association representative
Prof. David Lloyd Director, Gold Coast Orthopaedics Research, Engineering and Education, Griffith University
Prof. Kim Bennell Director of Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of
Melbourne
Prof. Peter Choong Sir Hugh Devine Chair of Surgery, Head of Department of Surgery, St. Vincent’s Hospital, University of
Melbourne
Ms. Lesley Brydon Founding CEO, PainAustralia (Retired); independent consumer representative
Dr. Yingyu Feng Project manager, University of Sydney

23. Osteoarthritis Summit 2018
National Osteoarthritis Strategy
Join us at the Osteoarthritis Summit 2018 on Tuesday 27 November. The summit will provide
the latest development on the National Osteoarthritis Strategy and an opportunity to move
the Strategy to a national implementation plan! Recommendations from the Strategy will
also feed into the National Strategic Action Plan for Arthritis.
Utilizing data, evaluation and evidence to drive quality
improvement

24. • Buy-in and coordinated action

25. • Departments of Health, esp those with OA models of
care: WA, VIC, NSW, SA
• WorkSafe/WorkCover authorities, targeting clinical
panels
• WorkSafe/WorkCover agents: QBE, Gallagher Basset,
CGU, Allianz, EML etc – focussing on injury
management advisors and medical advisors
• Health Insurers or their alliance group
• Arthritis associations in each state, Arthritis Australia,
MOVE, PainAustralia, BodyinMind
• Chronic Disease Alliance
• Australian Commission on Safety and Quality in
HealthCare
• NSW Agency for Clinical Innovation; WA Health
Networks
• E-portals, including painHEALTH, MyJointPain, Better
Health Channel
• RACP
• Aust Rheumatology Assoc
• Faculty of Rehab Medicine
• Faculty of Occupational and
Environmental Medicine
• Australasian College of Sports of Exercise
Medicine Physicians
• Australian Orthopaedic Assoc
• Australian Physiotherapy Assoc
• Occupational Therapy Australia
• Australian Podiatry Assoc
• Aust Assoc of Gerontology
• Australian Pain Society
• Australian Psychological Society
• Dietitians Assoc of Australia
• Chiropractic Assoc Australia
• Exercise and Sports Science Aust
• Australian Primary Care Nurses Association
Primary Health Networks across Australia,
including state alliance groups

26. The strategy was sent to 650+ stakeholders, and received 176 public
submissions from across all states/territories in Australia and the
globe.
 Capacity:
• 75% health practitioners
• 21% consumer
• 8 % researchers
 Main area of focus
• Osteoarthritis (57%)
• Regional conditions (19%)
• Inflammatory arthritis (13%)
 90% individuals & 10% as a
representative of an organisation
The Implementation Committee validated the proposed 26 strategies

27. Illustrate the burden
Create a compelling
narrative
Utilise knowledge
translation/
implementation
principles
Engage with and consult
relevant stakeholders that
may be unique for each
project
Examine your motives.
Maintain a focus on what is
important - keep consumers
engaged and at the centre of
your mindset
The obstacle is
the way

28. • Chris Little, USYD
• Kim Bennell, Univ Melb
• Paul Hodges, UQ
• Bill Vicenzino, UQ
• Manuela Ferreira, USYD
• Rana Hinman, Univ Melb
• Changhai Ding, UTAS
• James Linklater, USYD
• Peter Choong, Univ Melb
• Michelle Dowsey, Univ
Melb
• Justin Roe, UNSW
• David Lloyd, Griffith
• Stefan Lohmander, Lund
• Yuqing Zhang, MGH
• Steve Messier, Wake Forest
• Felix Eckstein, PMU
• Nigel Arden, Oxford
• Kent Kwoh, Arizona
• Virginia Kraus, Duke
• Ali Guermazi, Boston Univ
• Frank Roemer, Erlangen
• Grace Lo, Baylor
• Elena Losina, Harvard
• Jeff Katz, Harvard
• Michael Nevitt, UCSF
• Richard Loeser, UNC
• Tim McAlindon, Tufts
• David Wilson, UBC
• Young Jo Kim, Harvard

29. David.Hunter@sydney.edu.au
@ProfDavidHunter