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Arthritis Care Res (Hoboken). 2018 Jul 28. doi: 10.1002/acr.23716. [Epub ahead of print]

Cost-Effectiveness of Diet and Exercise for Overweight and Obese Knee Osteoarthritis Patients.

Author information

1
Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery.
2
Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
3
Yale School of Public Health.
4
Yale School of Medicine, New Haven, CT.
5
Veterans Affairs Medical Center, West Haven, CT.
6
Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
7
Division of Rheumatology.
8
Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC.

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 knee osteoarthritis (OA) patients. We investigated the cost-effectiveness of adding this D+E program to treatment for overweight and obese (BMI>27 kg/m2 ) knee OA patients.

METHODS:

We used the Osteoarthritis Policy Model to estimate quality-adjusted life-years (QALYs) and lifetime costs for overweight and obese knee OA patients 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 three cost-effectiveness thresholds: $50,000/QALY, $100,000/QALY, and $200,000/QALY. Analyses were conducted from healthcare 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 (PSA) evaluated parameter uncertainty and the effect of extending the D+E program duration.

RESULTS:

In the base case, D+E led to 0.054 QALYs gained per person and cost $1,845 from the healthcare sector perspective and $1,624 from the societal perspective. This resulted in ICERs of $34,100/QALY and $30,000/QALY. In the healthcare sector perspective PSA, D+E had a 58% and 100% likelihood 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 knee OA patients is cost-effective and should be implemented in clinical practice. This article is protected by copyright. All rights reserved.

PMID:
30055077
DOI:
10.1002/acr.23716

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