BACKGROUND: Exercise therapy is known to be an effective intervention for patients with osteoarthritis, however the evidence is limited as to whether adding manual therapy or booster sessions are cost-effective strategies to extend the duration of benefits. OBJECTIVE: To investigate the cost-effectiveness, at 2-year follow-up, of adding manual therapy and/or booster sessions to exercise therapy. DESIGN: 2-by-2 factorial randomized controlled trial. METHODS: Participants with knee osteoarthritis were randomly allocated (1:1:1:1) to: exercise therapy delivered in consecutive sessions within 9 weeks (control group), exercise therapy distributed over 1 year using booster sessions, exercise therapy plus manual therapy delivered within 9 weeks, and exercise therapy plus manual therapy with booster sessions. The primary outcome was incremental cost-effectiveness from health system and societal perspectives interpreted as incremental net monetary benefit (INMB). RESULTS: Of 75 participants, 66 (88%) were retained at 1-year and 40 (53%) at 2-year follow-up. All three interventions were cost-effective from both the health system and societal perspectives (INMBs, at 0.5 x GDP/capita willingness to pay (WTP) threshold $3,278 (95%CI -3,244 to 9,800) and $3,904 (95%CI -2,823 to 10,632) respectively for booster sessions; $2,941 (95%CI -3,686 to 9,568) and $2,618 (95%CI -4,005 to 9,241) for manual therapy; $270 (95%CI -6,139 to 6,679) and $404 (95%CI -6,097 to 6,905) for manual therapy with booster sessions). CONCLUSION: Manual therapy or booster sessions in addition to exercise therapy are cost-effective at 2-year follow-up. The evidence did not support combining both booster sessions and manual therapy in addition to exercise therapy.

Full text (sometimes free) may be available at these link(s):      help

• DOI
• PubMed
• PDF locator
• publisher