PMS19 A SYSTEMATIC REVIEW OF ECONOMIC MODELS FOR COST EFFECTIVENESS OF PHYSIOTHERAPY INTERVENTION FOLLOWING TOTAL KNEE AND HIP REPLACEMENT

Abstract

Osteoarthritis 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 and or hip replacement (TKHR), the long- term effectiveness of physiotherapy interventions may slowly accumulate over a period. This study reviewed the long-term cost- effectiveness (CE) of physiotherapy interventions for patients with TKHR. A literature search was carried out on AMED, MEDLINE, CINAHL, DARE, HTA, NHSEED and Cost- Effectiveness registry databases from inception to September 2019. Studies that assessed the long-term CE of physiotherapy interventions following TKHR using a decision analytic model, and published in English language. Methodological quality of the included studies were assessed using the Philips Checklist criteria. Two reviewers using a predefined data extraction form independently extracted data. A descriptive synthesis was used to present the results. Sixty-two studies were identified, and 3 met the inclusion criteria and were included. The average quality score of the studies included were 20 out of 32 (range 18-22). 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. One study included in the review also reported that physiotherapy (hydrotherapy) was dominant compared to the control. Based 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 intervention, patient compliance and price.