Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee

Abstract

BackgroundThere is limited information on the costs and benefits of alternative adjunct non-pharmacological treatments for knee osteoarthritis and little guidance on which should be prioritised for commissioning within the NHS. This study estimates the costs and benefits of acupuncture, braces, heat treatment, insoles, interferential therapy, laser/light therapy, manual therapy, neuromuscular electrical stimulation, pulsed electrical stimulation, pulsed electromagnetic fields, static magnets and transcutaneous electrical nerve Stimulation (TENS), based on all relevant data, to facilitate a more complete assessment of value.MethodsData from 88 randomised controlled trials including 7,507 patients were obtained from a systematic review. The studies reported a wide range of outcomes. These were converted into EQ-5D index values using prediction models, and synthesised using network meta-analysis. Analyses were conducted including firstly all trials and secondly only trials with low risk of selection bias. Resource use was estimated from trials, expert opinion and the literature. A decision analytic model synthesised all evidence to assess interventions over a typical treatment period (constant benefit over eight weeks or linear increase in effect over weeks zero to eight and dissipation over weeks eight to 16).ResultsWhen all trials are considered, TENS is cost-effective at thresholds of £20–30,000 per QALY with an incremental cost-effectiveness ratio of £2,690 per QALY vs. usual care. When trials with a low risk of selection bias are considered, acupuncture is cost-effective with an incremental cost-effectiveness ratio of £13,502 per QALY vs. TENS. The results of the analysis were sensitive to varying the intensity, with which interventions were delivered, and the magnitude and duration of intervention effects on EQ-5D.ConclusionsUsing the £20,000 per QALY NICE threshold results in TENS being cost-effective if all trials are considered. If only higher quality trials are considered, acupuncture is cost-effective at this threshold, and thresholds down to £14,000 per QALY.

Twelve-month analgesia and rescue, by cooled radiofrequency ablation treatment of osteoarthritic knee pain: results from a prospective, multicenter, randomized, cross-over trial

“…Chronic use of non-steroidal anti-inflammatory drugs can introduce gastrointestinal, cardiovascular, and renal complications18; opioids present the risk of tolerance and addiction with escalating dosage over time19; physical therapy requires routine visits that increase healthcare expenditures; corticosteroid injections have limited duration of efficacy20 21; viscosupplementation efficacy is equivocal,22 23 as is platelet-rich plasma compared with viscosupplementation,24 25 and bracing may not be cost-effective 26. A TKA is a well-established and successful procedure,1 2 but there are certain populations where one could argue for a more conservative option,27 such as when patients are not yet considered ‘operative’, or have comorbid health issues that would preclude them from surgery or increase the risk profile for undergoing a TKA.…”

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

“…6 Acupuncture therapy is effective in the treatment of chronic pain conditions [17][18][19][20] including chronic low back pain, [21][22][23][24] neck pain, [24][25][26] and knee pain from osteoarthritis. [27][28][29][30][31][32] A recently updated individual patient data meta-analyses including over 20,000 patients with chronic pain showed acupuncture to be significantly better than sham treatment or usual care with only a 15% reduction in treatment effect at 1 year. 33 Acupuncture therapy is supported or recommended as part of comprehensive pain care 12 by the Agency for Healthcare Research and Quality (AHRQ), 34 the American College of Physicians (ACP), 35 and the Joint Commission (TJC).…”

Cost‐utility of a six‐month programmed sports therapy (PST) in patients with haemophilia

“…The comparison of our results with the literature is limited, as, to our knowledge, no study on the cost‐utility of a sports therapy exists so far. In addition, it is not possible to compare results with cost‐utility analyses in diseases showing similar symptoms, for example osteoarthritis, because studies apply different time horizons and include older patients . Available studies in haemophilia investigated only fragments of the impact of sports therapy on the use of healthcare services or focused on the cost‐effectiveness of on‐demand factor treatment in comparison with prophylactic therapy .…”

“…In addition, it is not possible to compare results with costutility analyses in diseases showing similar symptoms, for example osteoarthritis, because studies apply different time horizons and include older patients. 35 Available studies in haemophilia investigated only fragments of the impact of sports therapy on the use of healthcare services or focused on the cost-effectiveness of on-demand factor treatment in comparison with prophylactic therapy. [16][17][18][19] Our results on the use of factor treatment are comparable with the study of Czepa et al, 20 in which an increase in the coagulation factor over a one-year sports therapy was not documented, either.…”