Send to

Choose Destination
Br J Sports Med. 2019 Jun 21. pii: bjsports-2018-100065. doi: 10.1136/bjsports-2018-100065. [Epub ahead of print]

How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study.

Author information

Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Health Sciences, VU University, Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, Clinical Orthopaedic Research Centre - mN, Diakonessenhuis, Utrecht, The Netherlands.
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, United States.



To examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a societal perspective. In a secondary analysis-this paper-we examined whether PT is non-inferior to APM.


We recruited patients aged 45-70 years with a non-obstructive meniscal tear in nine Dutch hospitals. Resource use was measured using web-based questionnaires. Measures of effectiveness included knee function using the International Knee Documentation Committee (IKDC) and quality-adjusted life-years (QALYs). Follow-up was 24 months. Uncertainty was assessed using bootstrapping techniques. The non-inferiority margins for societal costs, the IKDC and QALYs, were €670, 8 points and 0.057 points, respectively.


We randomly assigned 321 patients to PT (n=162) or APM (n=159). PT was associated with significantly lower costs after 24 months compared with APM (-€1803; 95% CI -€3008 to -€838). The probability of PT being cost-effective compared with APM was 1.00 at a willingness to pay of €0/unit of effect for the IKDC (knee function) and QALYs (quality of life) and decreased with increasing values of willingness to pay. The probability that PT is non-inferior to APM was 0.97 for all non-inferiority margins for the IKDC and 0.89 for QALYs.


The probability of PT being cost-effective compared with APM was relatively high at reasonable values of willingness to pay for the IKDC and QALYs. Also, PT had a relatively high probability of being non-inferior to APM for both outcomes. This warrants further deimplementation of APM in patients with non-obstructive meniscal tears.


NCT01850719 and NTR3908.


arthroscopic partial meniscectomy; economic evaluation; knee; physical therapy; randomised controlled trial

Free full text

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: all authors had financial support from The Netherlands Organisation for Health Research and Development (in Dutch: ZonMw) for the submitted work; the Achmea Healthcare Foundation (in Dutch Stichting Achmea Gezonheidszorg fonds) and the foundation of medical research at the OLVG, Amsterdam, the Netherlands; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center