Abstract
BackgroundThe prevalence of knee osteoarthritis is increasing worldwide. Obesity is an important modifiable risk factor for both the incidence and progression of knee osteoarthritis. Consequently, international guidelines recommend all patients with knee osteoarthritis who are overweight receive support to lose weight. However, few overweight patients with this condition receive care to support weight loss. Telephone-based interventions are one potential solution to provide scalable care to the many patients with knee osteoarthritis. The objective of this study is to evaluate, from a societal perspective, the cost-utility and cost-effectiveness of a telephone-based weight management and healthy lifestyle service for patients with knee osteoarthritis, who are overweight or obese.MethodsAn economic evaluation was undertaken alongside a pragmatic randomised controlled trial. Between May 19 and June 30, 2015, 120 patients with knee osteoarthritis were randomly assigned to an intervention or usual care control group in a 1:1 ratio. Participants in the intervention group received a referral to an existing non-disease specific 6-month telephone-based weight management and healthy lifestyle service. Quality-adjusted life years (QALYs) was the utility measure and knee pain intensity, disability, weight, and body mass index (BMI) were the clinical measures of effect. Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain. Data was collected at baseline, 6 weeks and 26 weeks. The primary cost-effectiveness analysis was performed from the societal perspective.ResultsMean cost differences between groups (intervention minus control) were $493 (95%CI: -3513 to 5363) for healthcare costs, $-32 (95%CI: -73 to 13) for medication costs, and $125 (95%CI: -151 to 486) for absenteeism costs. The total mean difference in societal costs was $1197 (95%CI: -2887 to 6106). For QALYs and all clinical measures of effect, the probability of the intervention being cost-effective compared with usual care was less than 0.36 at all willingness-to-pay values.ConclusionsFrom a societal perspective, telephone-based weight loss support, provided using an existing non-disease specific 6-month weight management and healthy lifestyle service was not cost-effective in comparison with usual care for overweight and obese patients with knee osteoarthritis.Trial registration numberACTRN12615000490572, registered 18th May 2015
Highlights
The prevalence of knee osteoarthritis is increasing worldwide
These treatments are delivered using clinical face-to-face models of care [12]. While such clinical models produce moderate effects on weight loss, pain, and physical function [7, 8], only 22% of patients with knee osteoarthritis referred for orthopaedic consultation at a large Australian public hospital report receiving weight loss care [13], possibly due to limitations in service delivery and patient access to care
We found that referral to a telephone-based weight management and healthy lifestyle service was not cost-effective from a societal perspective for patients with knee osteoarthritis who are overweight or obese, compared with usual care
Summary
The prevalence of knee osteoarthritis is increasing worldwide. Obesity is an important modifiable risk factor for both the incidence and progression of knee osteoarthritis. International guidelines recommend all patients with knee osteoarthritis who are overweight receive support to lose weight. International clinical practice guidelines recommend all patients with knee osteoarthritis who are overweight receive support to lose weight [9,10,11]. These treatments are delivered using clinical face-to-face models of care [12]. While telephone-based behavioural interventions targeting weight loss are used routinely in the general populations, the cost-effectiveness of referring patients with knee osteoarthritis to these is unknown
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