Economic evaluation of telephone-based weight loss support for patients with knee osteoarthritis: a randomised controlled trial

Abstract

BackgroundThe prevalence of knee osteoarthritis is increasing worldwide. Obesity is an important modifiable risk factor for both the incidence and progression of knee osteoarthritis. Consequently, international guidelines recommend all patients with knee osteoarthritis who are overweight receive support to lose weight. However, few overweight patients with this condition receive care to support weight loss. Telephone-based interventions are one potential solution to provide scalable care to the many patients with knee osteoarthritis. The objective of this study is to evaluate, from a societal perspective, the cost-utility and cost-effectiveness of a telephone-based weight management and healthy lifestyle service for patients with knee osteoarthritis, who are overweight or obese.MethodsAn economic evaluation was undertaken alongside a pragmatic randomised controlled trial. Between May 19 and June 30, 2015, 120 patients with knee osteoarthritis were randomly assigned to an intervention or usual care control group in a 1:1 ratio. Participants in the intervention group received a referral to an existing non-disease specific 6-month telephone-based weight management and healthy lifestyle service. Quality-adjusted life years (QALYs) was the utility measure and knee pain intensity, disability, weight, and body mass index (BMI) were the clinical measures of effect. Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain. Data was collected at baseline, 6 weeks and 26 weeks. The primary cost-effectiveness analysis was performed from the societal perspective.ResultsMean cost differences between groups (intervention minus control) were $493 (95%CI: -3513 to 5363) for healthcare costs, $-32 (95%CI: -73 to 13) for medication costs, and $125 (95%CI: -151 to 486) for absenteeism costs. The total mean difference in societal costs was $1197 (95%CI: -2887 to 6106). For QALYs and all clinical measures of effect, the probability of the intervention being cost-effective compared with usual care was less than 0.36 at all willingness-to-pay values.ConclusionsFrom a societal perspective, telephone-based weight loss support, provided using an existing non-disease specific 6-month weight management and healthy lifestyle service was not cost-effective in comparison with usual care for overweight and obese patients with knee osteoarthritis.Trial registration numberACTRN12615000490572, registered 18th May 2015Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6300-1) contains supplementary material, which is available to authorized users.

Dietitians Australia position statement on telehealth

“…In chronic disease studies specifically, comparing telephone‐delivered nutrition consultations to usual care (including those with ad hoc nutrition care), four of five interventions were found to be cost‐effective 38,67‐69 in people with diabetes, hypertension, chronic kidney disease and people undergoing cardiac rehabilitation. However, the intervention in one of the five studies conducted in osteoarthritis patients was not cost‐effective when compared with usual care 70 …”

“…However, the intervention in one of the five studies conducted in osteoarthritis patients was not cost-effective when compared with usual care. 70 For cost-effectiveness of emerging telehealth interventions, a systematic review (2020, n = 23 studies) in type 2 diabetes reported mHealth interventions were highly costeffective, with cost per Quality Adjusted Life Years (QALY) gained ranging from 0.4% to 62.5% of GDP per capita. The costs varied depending on the number and type of technologies employed that ranged from one technology to three.…”

Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review

“…compared to physician-delivered usual care for participants with knee OA waiting for a surgical consultation in AU. 35…”

Cost-effectiveness of telehealth-delivered diet and exercise interventions: A systematic review

“…Sixteen studies clearly reported incremental cost-effectiveness ratios (ICERs) as an economic evaluation outcome, with 11stating the WTP threshold used. ICERs varied widely from being cost saving 8,42,44 to AUD$58,182 per QALY 23 . An economic evaluation conducted alongside the Telerehab III clinical trial in Belgium 42 found that the addition of a cardiac telerehabilitation programme to usual centre-based cardiac rehabilitation was more effective than usual rehabilitation alone with an ICER of -€21,707 per QALY.…”

“…Of the four studies with inconclusive results, one assessed a dietary intervention 34 , one an exercise intervention 39 , and two assessed a combination of diet and exercise 27,36 . Of eight studies reporting non-cost effectiveness, three assessed exercise only 31,33,46 , and five assessed a combination 23,24,30,38,41,45 .…”