Article

Limited information exists regarding the cost-effectiveness of
rehabilitation strategies for individuals with knee osteoarthritis (OA).
Objective: The study objective was to compare the cost-effectiveness of 4
different combinations of exercise, manual therapy, and booster sessions for
individuals with knee OA.
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 knee OA. 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 United States 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 ${\$}$1061 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 knee OA 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 knee OA.
CI - (c) 2017 American Physical Therapy Association

Langue : ANGLAIS