A systematic review of economic models for cost effectiveness of physiotherapy interventions following total knee and hip replacement

Abstract

BackgroundOsteoarthritis is a primary cause of pain and disability, and it places a considerable economic burden on individuals and the society. In the management of total knee or hip replacement (TKHR), the long-term effectiveness of physiotherapy interventions may slowly accumulate over a period. ObjectivesTo evaluate all the model-based cost-effectiveness (CE) of physiotherapy interventions for patients with (TKHR). Data sourcesA literature search was carried out on AMED, MEDLINE, CINAHL, DARE, HTA, NHSEED and cost-effectiveness registry databases from inception to May 2021. Study selectionStudies that assessed model-based CE of physiotherapy interventions following TKHR and were published in English language. The methodological quality of the included studies were assessed using the Philips Checklist criteria. Data extraction/data synthesisTwo reviewers, using a predefined data extraction form, independently extracted data. A descriptive synthesis was used to present the results. ResultEight hundred eighty-six studies were identified, and the only 3 that met the inclusion criteria were included. Different model structures and assumptions were used in the included studies. The included studies were conducted in the United States of America (n=1), Singapore (n=1) and Italy (n=1). The societal (n=2) and healthcare (n=1) perspective were adopted in the studies. The included studies reported an incremental cost effectiveness ratio (ICER) of $57,200 and 27,471 Singapore dollar (SGD) per quality-adjusted life years in a time horizon of lifetime and three months, respectively. Physiotherapy (hydrotherapy) interventions were potentially cost-effective. ConclusionBased on the best available evidence, the findings of this review suggest that physiotherapy interventions were CE and cost saving. However, it is important to note that among others the CE of the interventions was a function of the healthcare system, duration of interventions, patient compliance and price. Systematic review registration number CRDCRD42019151214.