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ACR Open Rheumatol. 2020 Jan;2(1):26-36. doi: 10.1002/acr2.11090. Epub 2019 Nov 19.

Budget Impact of Funding an Intensive Diet and Exercise Program for Overweight and Obese Patients With Knee Osteoarthritis.

Author information

1
Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Brigham and Women's Hospital, Boston, Massachusetts.
2
Harvard Medical School, Boston, Massachusetts.
3
J.B. Snow Biomechanics Laboratory, Wake Forest University, Winston-Salem, North Carolina.
4
University of Sydney, Sydney, Australia.
5
Yale School of Public Health, New Haven, Connecticut.

Abstract

OBJECTIVE:

Diet and exercise (D+E) for knee osteoarthritis (OA) is effective and cost-effective. However, cost-effectiveness does not imply affordability; the impact of knee OA-specific D+E programs on insurer budgets is unknown.

METHODS:

We estimated changes in undiscounted medical expenditures (2016 US dollars) with and without a D+E program. We accounted for both additional program outlays and potential savings from reduced use of other knee OA treatments and from reduced incidence of comorbidities. We adopted the perspective of a representative commercial insurance plan covering 200 000 individuals aged 25 to 64 years and a representative Medicare Advantage plan covering 200 000 Medicare-eligible individuals aged 65 years and older. We used the Osteoarthritis Policy Model, a validated microsimulation model of knee OA, to model D+E efficacy (measured by pain and weight reduction), adherence, and price based on the Intensive Diet and Exercise for Arthritis (IDEA) trial. In sensitivity analyses, we varied time horizon, D+E efficacy, and D+E price.

RESULTS:

Over 3 years, the D+E program increased spending by $752 200 ($0.10 per member per month [PMPM]) in the commercial plan and by $6.0 million ($0.84 PMPM) in the Medicare plan. Over 3 years, the D+E program reduced opioid use by 6% and 5% and reduced total knee replacements by 5% and 4% in the commercial and Medicare plans, respectively. Expenses were higher in the Medicare plan because it had more patients with knee OA than the commercial plan.

CONCLUSION:

Although there is no established threshold to define affordability, a D+E program for knee OA would likely produce expenditures comparable with outlays for other health-promotion interventions.

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