Economic evaluation of multidisciplinary rehabilitation after primary total knee arthroplasty based on a randomized controlled trial

Abstract

Objective. To conduct an economic evaluation of a multidisciplinary, biopsychosocial outpatient rehabilitation program implemented 2-4 months after total knee arthroplasty (TKA), compared with conventional orthopedic care. Methods. After surgery, 86 patients were randomized to a multidisciplinary rehabilitation group (n ‫؍‬ 44) or a conventional orthopedic care group (n ‫؍‬ 42). Alongside the randomized controlled trial, we estimated the costs of rehabilitation, health care resource use, and community support. Information about resource use was collected by means of a questionnaire together with data from hospital records. The primary outcome (effectiveness) measure was change in self-reported functional capacity and the secondary measure was quality-adjusted life years (QALYs) gained during the 12-month followup. Cost-effectiveness was assessed from between-group differences in costs, change in functional capacity, and QALYs gained. Results. Both protocols of providing rehabilitation services turned out to be equally effective, but the conventional orthopedic care protocol was unequivocally cost saving: the saving was €1,830 per patient (95% confidence interval ؊548, 3,623) using the available direct cost data. Conclusion. Multidisciplinary rehabilitation for unselected osteoarthritis patients in the subacute period of recovery after TKA is not a cost-effective use of health care resources. Similar rehabilitation protocols cannot be recommended for clinical pathways of TKA in the future.

Prevalence and Costs of Rehabilitation and Physical Therapy After Primary TJA

“…Achievement of further cost savings will require a variety, yet to be evaluated, of fast track modalities aimed at increasing home health utilization. These modalities may necessitate such strategies as increased use of preadmission education and training [30,[32][33][34], more attention to the psychosocial events surrounding the surgery [16,35], and changing patient and surgeon expectations [36][37][38]. Direct discharge to home with home care has been suggested to be an optimal strategy for patients after TJA who were healthy and had social support [39].…”

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

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The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study

“…Meeting patients' needs is not straightforward because patients may make choices that do not accord with clinical definitions of 'good care'. The value of Mol's work is the focus on a concept of 'good care', 86 in which patients are not necessarily provided with unfettered choice, but in which care is negotiated between patients and health-care professionals. The role of health-care professionals, then, is to offer advice and encouragement and adapt care when possible to meet patient preferences and needs.…”