Economic evaluation of a rehabilitation program integrating exercise, self‐management, and active coping strategies for chronic knee pain

Abstract

Objective. To conduct an economic evaluation of the Enabling Self-Management and Coping with Arthritic Knee Pain through Exercise (ESCAPE-knee pain) program. Methods. Alongside a clinical trial, we estimated the costs of usual primary care and participation in ESCAPE-knee pain delivered to individuals (Indiv-rehab) or groups of 8 participants (Grp-rehab). Information on resource use and informal care received was collected during face-to-face interviews. Cost-effectiveness and cost-utility were assessed from betweengroup differences in costs, function (primary clinical outcome), and quality-adjusted life years (QALYs). Cost-effectiveness acceptability curves were constructed to represent uncertainty around cost-effectiveness. Results. Rehabilitation (regardless of whether Indiv-rehab or Grp-rehab) cost £224 (95% confidence interval [95% CI] £184, £262) more per person than usual primary care. The probability of rehabilitation being more cost-effective than usual primary care was 90% if decision makers were willing to pay £1,900 for improvements in functioning. Indiv-rehab cost £314/person and Grp-rehab £125/person. Indiv-rehab cost £189 (95% CI £168, £208) more per person than Grp-rehab. The probability of Indiv-rehab being more cost-effective than Grp-rehab increased as willingness to pay (WTP) increased, reaching 50% probability at WTP £5,500. The lack of differences in QALYs across the arms led to lower probabilities of cost-effectiveness based on this outcome. Conclusion. Provision of ESCAPE-knee pain had small cost implications, but it was more likely to be cost-effective in improving function than usual primary care. Group rehabilitation reduces costs without compromising clinical effectiveness, increasing probability of cost-effectiveness.

Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence

“…[29][30][31][32] It should be noted that one study found exercise interventions were effective for functional improvements compared with 'usual care'. 19 However, greater gains in quality-of-life measures were found in the 'usual care' group than in the 'exercise' intervention groups (negative cost per QALY), so the cost per QALY was difficult to interpret. 19 Comparing the annual cost per participant to become active is difficult due to the different definitions and analytical approaches used.…”

Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials

“…123,124 Data from the cohort study indicated that many patients only consult their GP about their condition once within a period of 3 years. Patients consulting their GP were likely to be initially offered advice and pain medication(s) according to the severity of their symptoms and, thereafter, stronger pain medications, referral for physiotherapy and eventually surgery as the last treatment option if the pain persisted.…”

“…Owing to the lack of detailed data on health-care resource use in the cohort, the costs of current care were considered to be as reported in the control arm (current GP-led care) in a trial of exercise in knee OA patients. 123,124 Treatments included advice, exercise and pain medication(s) including simple analgesia (paracetamol and aspirin), topical and oral NSAIDs, and opioids. Table 3 contains information on the baseline proportion of patients in each health state at baseline and provides estimates for the clinical effectiveness of individual treatments.…”

“…Table 5 shows the unit cost data applied in this study. The cost of current care for each pain severity health state was estimated using patient-level data from the current-care arm of the exercise trial by Hurley et al 124 The unit cost of drugs was updated from a price year of 2003/4 to 2010 using British National Formulary (BNF) costs 126 and an average cost per 3 months of treatment calculated.…”

“…Other large trials in knee OA have found that prolonged exercise interventions (involving up to 12 sessions of individualised, physiotherapy-led exercise regimens) provide short-term (6 months) and smaller long-term benefits (12 and 30 months) and are cost-effective compared with usual GP care. 123,124,270 We have previously shown that physiotherapy-led exercise is superior to usual GP-led care supplemented with an advice leaflet. 34 In that trial, an average of four treatment sessions was provided and this resulted in 37% of participants being classified as treatment responders at 6 months.…”