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| Exercise, manual therapy, and booster sessions in knee osteoarthritis: cost-effectiveness analysis from a multicenter randomized controlled trial |
| Bove AM, Smith KJ, Bise CG, Fritz JM, Childs J, Brennan GP, Abbott JH, Fitzgerald GK |
| Physical Therapy 2018 Jan;98(1):16-27 |
| clinical trial |
| 4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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BACKGROUND: Limited information exists regarding the cost-effectiveness of rehabilitation strategies for individuals with knee osteoarthritis (KOA). OBJECTIVE: The study objective was to compare the cost-effectiveness of 4 different combinations of exercise, manual therapy, and booster sessions for individuals with KOA. DESIGN: This economic evaluation involved a cost-effectiveness analysis performed alongside a multicenter randomized controlled trial. SETTING: The study took place in Pittsburgh, Pennsylvania; Salt Lake City, Utah; and San Antonio, Texas. PARTICIPANTS: The study participants were 300 individuals taking part in a randomized controlled trial investigating various physical therapy strategies for KOA. INTERVENTION: Participants were randomized into 4 treatment groups: exercise only (EX), exercise plus booster sessions (EX+B), exercise plus manual therapy (EX+MT), and exercise plus manual therapy and booster sessions (EX+MT+B). MEASUREMENTS: For the 2-year base case scenario, a Markov model was constructed using the US societal perspective and a 3% discount rate for costs and quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios were calculated to compare differences in cost per QALY gained among the 4 treatment strategies. RESULTS: In the 2-year analysis, booster strategies (EX+MT+B and EX+B) dominated no-booster strategies, with both lower health care costs and greater effectiveness. EX+MT+B had the lowest total health care costs. EX+B cost $1,061 more and gained 0.082 more QALYs than EX+MT+B, for an incremental cost-effectiveness ratio of $12,900/QALY gained. LIMITATIONS: The small number of total knee arthroplasty surgeries received by individuals in this study made the assessment of whether any particular strategy was more successful at delaying or preventing surgery in individuals with KOA difficult. CONCLUSIONS: 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 KOA.
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