Cost‐Effectiveness of Diet and Exercise for Overweight and Obese Patients With Knee Osteoarthritis. Issue 7 (27th June 2019)

• Record Type: Journal Article
• Authors: Losina, Elena; Smith, Karen C.; Paltiel, A. David; Collins, Jamie E.; Suter, Lisa G.; Hunter, David J.; Katz, Jeffrey N.; Messier, Stephen P.
• Is Part Of: Arthritis care & research. Volume 71:Issue 7(2019)
• Page Start: 855
• Page End: 864
• Publication Date: 2019-06-27
• Subjects: Arthritis -- Periodicals; Rheumatism -- Periodicals; 616.72
• DOI: 10.1002/acr.23716
• Languages: English
• ISSNs: 2151-464X

Abstract

Abstract : Objective: The Intensive Diet and Exercise for Arthritis (IDEA) trial showed that an intensive diet and exercise (D+E) program led to a mean 10.6‐kg weight reduction and 51% pain reduction in patients with knee osteoarthritis (OA). The aim of the current study was to investigate the cost‐effectiveness of adding this D+E program to treatment in overweight and obese (body mass index >27 kg/m 2 ) patients with knee OA. Methods: We used the Osteoarthritis Policy Model to estimate quality‐adjusted life‐years (QALYs) and lifetime costs for overweight and obese patients with knee OA, with and without the D+E program. We evaluated cost‐effectiveness with the incremental cost‐effectiveness ratio (ICER), a ratio of the differences in lifetime cost and QALYs between treatment strategies. We considered 3 cost‐effectiveness thresholds: $50, 000/QALY, $100, 000/QALY, and $200, 000/QALY. Analyses were conducted from health care sector and societal perspectives and used a lifetime horizon. Costs and QALYs were discounted at 3% per year. D+E characteristics were derived from the IDEA trial. Deterministic and probabilistic sensitivity analyses (PSAs) were used to evaluate parameter uncertainty and the effect of extending the duration of the D+E program. Results: In the base case, D+E led to 0.054 QALYs gained per person and cost $1, 845 from the health care sector perspective and $1, 624 from the societal perspective. This resulted in ICERs of $34, 100/QALY and $30, 000/QALY. In the health care sector perspective PSA, D+E had 58% and 100% likelihoods of being cost‐effective with thresholds of $50, 000/QALY and $100, 000/QALY, respectively. Conclusion: Adding D+E to usual care for overweight and obese patients with knee OA is cost‐effective and should be implemented in clinical practice.