Cost-effectiveness of 12 weeks of supervised treatment compared to written advice in patients with knee osteoarthritis: a secondary analysis of the 2-year outcome from a randomized trial

Abstract

Objective: To assess the 24-month cost-effectiveness of supervised treatment compared to written advice in knee osteoarthritis (OA). Design: 100 adults with moderate-severe OA not eligible for total knee replacement (TKR) randomized to a 12-week individualized, supervised treatment (exercise, education, diet, insoles and pain medication) or written advice. Effectiveness was measured as change in quality-adjusted life years (QALYs) from baseline to 24 months, including data from baseline, 3, 6, 12 and 24 months, while healthcare costs and transfer payments were derived from national registries after final follow-up. Incremental costs, qualityadjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. A sensitivity analysis resampling existing data was conducted and the probability of cost-effectiveness was estimated using a 22,665 Euros/QALY threshold. In a sensitivity analysis, cost-effectiveness was calculated for different costs of the supervised treatment (actual cost in study; cost in private practice; and inbetween cost). Results: Average costs were similar between groups (6,758 Euros vs 6,880 Euros), while the supervised treatment were close to being more effective (incremental effect (95% CI) of 0.075 (À0.005 to 0.156). In the primary analysis excluding deaths, this led the supervised treatment to be cost-effective, compared to written advice. The sensitivity analysis demonstrated that the results were sensitive to changes in the cost of treatment, but in all scenarios the supervised treatment was cost-effective (ICERs of 6,229 to 20,688 Euros/QALY). Conclusions: From a 24-month perspective, a 12-week individualized, supervised treatment program is cost-effective compared to written advice in patients with moderate-severe knee OA not eligible for TKR. Trial registration: ClinicalTrials.gov number: NCT01535001.

Five-year follow-up of patients with knee osteoarthritis not eligible for total knee replacement: results from a randomised trial

“…38 39 Limitations Given that the 95% CI (−1.5 to 12.1) of the main outcome KOOS 4 and 3 out of 5 KOOS subscales included the minimal clinically important difference (10 points), the true difference in change between groups could potentially be clinically relevant in favour of the nonsurgical treatment group. While a 2-year analyses of the study demonstrated that the MEDIC treatment was costeffective as compared with written advice, 40 the 5-year cost-effectiveness is unknown. The improvements from baseline to 5 years in both treatment groups could be influenced by regression towards the mean, that is, patients originally sought medical care when their symptoms were most intolerable.…”

Program evaluation of GLA:D® Australia: Physiotherapist training outcomes and effectiveness of implementation for people with knee osteoarthritis

“…Guidelines [ [8] , [9] , [10] ] recommend patient education, exercise-therapy and weight management where indicated as first-line care for knee osteoarthritis. Patient education and exercise-therapy are cost-effective [ 11 , 12 ], can avert surgery [ 13 , 14 ] and have compelling evidence of effectiveness including moderate pain and function improvements compared to control interventions, regardless of radiographic or pain severity [ [15] , [16] , [17] ].…”

Cost-effectiveness of an 8-week supervised education and exercise therapy programme for knee and hip osteoarthritis: a pre–post analysis of 16 255 patients participating in Good Life with osteoArthritis in Denmark (GLA:D)

“…Previous analyses of the GLA:D programme, but with twice the number of supervised neuromuscular exercise sessions, weight loss, insoles and pain medication if needed, have found similar results. 15 31 A model-based study suggested that exercise therapy and education was cost-effective as compared with usual care for patients with knee or hip OA in Canada, 31 while an analysis of results from a randomised trial comparing supervised exercise therapy, education and other recommended non-surgical interventions to written advice in patients with moderate to severe knee OA found the intervention to be cost-effective with incremental cost effectiveness ratios of 6229 to 20 688€/QALY. 15 Even though our study is a pre–post study and therefore not directly comparable, our findings are also in line with other previous studies which have indicated that supervised exercise therapy alone as treatment for OA is cost-effective.…”

“… 15 31 A model-based study suggested that exercise therapy and education was cost-effective as compared with usual care for patients with knee or hip OA in Canada, 31 while an analysis of results from a randomised trial comparing supervised exercise therapy, education and other recommended non-surgical interventions to written advice in patients with moderate to severe knee OA found the intervention to be cost-effective with incremental cost effectiveness ratios of 6229 to 20 688€/QALY. 15 Even though our study is a pre–post study and therefore not directly comparable, our findings are also in line with other previous studies which have indicated that supervised exercise therapy alone as treatment for OA is cost-effective. Three randomised trials demonstrated that supervised exercise therapy in addition to usual care, supplementary class-based exercise in addition to a home-based programme and supervised exercise therapy compared with general practitioner care alone was likely to be cost-effective in people with knee and/or hip OA.…”