Exercise, Manual Therapy, and Booster Sessions in Knee Osteoarthritis: Cost-Effectiveness Analysis From a Multicenter Randomized Controlled Trial

Bove, Allyn M; Smith, Kenneth J.; Bise, Christopher G.; Fritz, Julie M.; Childs, John D.; Brennan, Gerard; Abbott, J. Haxby; Fitzgerald, G. Kelley

doi:10.1093/ptj/pzx104

Cited by 33 publications

(42 citation statements)

References 35 publications

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“…Other studies 26 , 27 , 37 , 38 have assessed the cost-effectiveness of physical therapy for knee osteoarthritis. Bove and colleagues 26 compared 4 physical therapy regimens: exercise and manual therapy or exercise alone, each with and without booster treatment sessions.…”

Section: Discussionmentioning

confidence: 99%

“…The willingness-to-pay (WTP) estimates usually vary by country, with more developed countries often willing to pay more for improvements in QALYs. Although there is no universal consensus for what ICER threshold should be used in the US, we used the threshold of $100 000 per QALY because it is commonly used in the US, particularly with osteoarthritis populations, 26 , 27 , 28 with compelling arguments to justify it as the minimum threshold. 29 , 30 To express the most cost-effective strategy of the base case in US dollars, we used the net monetary benefit framework to demonstrate the net benefit of each strategy (net monetary benefit = [incremental effectiveness × WTP] – incremental cost).…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis

et al. 2022

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Key Points Question Is an initial treatment of physical therapy cost-effective compared with an initial treatment of glucocorticoid injection for patients with knee osteoarthritis? Findings In this economic evaluation that included 156 adults participating in a randomized clinical trial, participants receiving physical therapy gained more quality-adjusted life-years compared with those receiving glucocorticoid injection. Costs related to knee care were similar between groups, although total medical costs for any reason were higher in the physical therapy group. Meaning The results of this study suggest that although the mean cost of providing an initial course of physical therapy may be higher than an initial course of glucocorticoid injections, the greater improvement in quality-adjusted life-years may be worth the additional cost.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis

et al. 2022

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“…This finding is in accordance with national and international guidelines that recommend the use of QALYs (70). Importantly, the calculation of QALYs relies on HSUs that can be obtained from a variety of sources, such as primary studies (37), systematic reviews (47), or randomized controlled trials (71). Because different populations may value health states differently, caution is required when using nonlocally derived HSUs (37,72).…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of the Evolution of Health‐Economic Evaluation Models of Osteoarthritis

Zhao

Ahmad

Graaff

et al. 2021

Arthritis Care & Research

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ObjectiveTo comprehensively synthesise the evolution of health-economic evaluation models (HEEMs) of all OA interventions including preventions, core treatments, adjunct non-pharmacological interventions, pharmacological and surgical treatments. MethodsThe literature was searched within health-economic/biomedical databases. Data extracted included: OA type, population characteristics, model setting/type/events, study perspective, comparators; and the reporting quality of the studies was assessed. The review protocol was registered at the International Prospective Register of Systematic Reviews (registration: CRD42018092937). ResultsEighty-eight studies were included. Pharmacological and surgical interventions were the focus in 51% and 44% studies, respectively. Twenty-four studies adopted a societal perspective (with increasing popularity after 2013), however most (63%) did not include indirect costs. Qualityadjusted life years (QALYs) was the most popular outcome measure since 2008. Markov models were used by 62% of studies, with increasing popularity since 2008. Until 2010, most studies used short-to-medium time horizons; subsequently a lifetime horizon became popular. Eighty-six percent of studies reported discount rate(s) (predominantly between 3% and 5%).Studies published after 2002 had a better coverage of OA-related adverse events (AEs).Reporting quality significantly improved after 2001. Conclusions 3OA HEEMs have evolved and improved substantially over time, with focus shifting from shortto-medium-term pharmacological decision-tree models to surgical-focused lifetime Markov models. Indirect costs of OA are frequently not considered, despite using a societal perspective.There was lack of reporting sensitivity of model outcome to input parameters including discount rate, OA definition, and population parameters. Whilst the coverage of OA-related AEs has improved over time, it is still not comprehensive.

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“…Conservative methods to treat hip osteoarthritis include pharmaceutical treatment, exercise therapy, thermotherapy, and surgeries such as osteotomy and arthroplasty, depending on a patient’s general condition and progress in the alleviation of symptoms [ 3 ]. Among the conservative treatments, exercise therapy has the advantage of fewer adverse effects on internal organs, it can be practiced anywhere, and at little cost [ 4 ]. Moreover, exercise therapy in a patient’s home is effective for gait ability and activities of daily living owing to improvement in joint stability, muscle strength, and range of motion [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Exercise Therapy Interventions in Patients With Hip Osteoarthritis: Comparison of the Effects of DVD and Website-Based Interventions

Uesugi¹,

Koyanagi²,

Takagi³

et al. 2018

JMIR Rehabil Assist Technol

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BackgroundPrevalence of developmental hip dysplasia is high in Japan. Exercise therapy has been proven effective to treat certain aspects of hip osteoarthritis. Moreover, therapy provided via digital video discs (DVDs) and websites allows patients to exercise in the comfort of their own homes. However, no studies have evaluated the effectiveness of visual instructions in patients with hip disorders.ObjectiveThis study aimed to compare the effectiveness of exercise therapy administered via DVD and that administered via a website.MethodsWe developed a six-step progressive exercise therapy program for patients with hip osteoarthritis, which included three kinds each of open kinetic chain and closed kinetic chain exercises. Once the program was developed, exercise DVDs were produced. In addition to the six-step exercise program, our website was enabled to count the number of exercises performed by each patient and was accessible via the Internet at any time. Patients with hip osteoarthritis for whom surgery was not advised were enrolled by one university hospital in the Kansai area in Japan. Clinical symptoms and hip function were quantified using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) and the Oxford Hip Score (OHS). Quality of life was measured using the SF-8 Health Survey, and self-efficacy for continued exercise was measured using the General Self-Efficacy Scale (GSES). Questionnaires were completed preintervention and after 6 months.ResultsAt 6-month follow-up, 10 DVD users (1 male, 9 female; mean age 51.3, SD 16.1 years) and 18 website users (2 male, 16 female; mean age 52.4, SD 10.4 years) were reachable. The change in each parameter could not be confirmed a significant improvement. However, most items tended to reflect overall improvement during the 6 months of intervention (P=.05-.94; paired t test). Regarding effect size, we considered a small effect to be greater than 0.2. Little effect was observed for JHEQ pain, SF-8 physical component summary (PCS), and SF-8 mental component summary in the DVD group, as well as OHS, SF-8 (PCS), and GSES in the website group.ConclusionsWhen comparing the effectiveness of exercise therapy between our DVD and website, we found that although both groups tended to improve in physical function, only the website group showed tendency of enhanced self-efficacy.

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Exercise, Manual Therapy, and Booster Sessions in Knee Osteoarthritis: Cost-Effectiveness Analysis From a Multicenter Randomized Controlled Trial

Abstract: Spacing exercise-based physical therapy sessions over 12 months using periodic booster sessions was less costly and more effective over 2 years than strategies not containing booster sessions for individuals with knee OA.

Cited by 33 publications

References 35 publications

Cost-effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis

Cost-effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis

Systematic Review of the Evolution of Health‐Economic Evaluation Models of Osteoarthritis

Exercise Therapy Interventions in Patients With Hip Osteoarthritis: Comparison of the Effects of DVD and Website-Based Interventions

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