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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.

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



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.


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.


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.


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.


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