Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain

TY - JOUR

T1 - Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain

AU - Hurley, Michael

AU - Walsh, N.E.

AU - Mitchell, H.L.

AU - Pimm, T.J.

AU - Williamson, E

AU - Jones, R.H.

AU - Reeves, B.C.

AU - Dieppe, P.A.

AU - Patel, A

PY - 2007/10/15

Y1 - 2007/10/15

N2 - Background Expenditure on chronic knee pain is great and increasing. ESCAPE-knee pain is a safe, effective rehabilitation programme designed to improve functioning, but when planning provision of healthcare commissioners also require cost and cost-effectiveness evidence. This report details the economic evaluation of ESCAPE-knee pain. Methods Alongside a clinical trial, we estimated the costs of usual primary care and participation on ESCAPE-knee pain delivered to individuals (Indiv-rehab) or in groups of 8 participants (Grp-rehab). Resource use and informal care received were collected during face-to-face interviews. Cost-effectiveness and cost-utility were assessed from between-group differences in costs, function (primary clinical outcome) and quality-adjusted life years (QALYs). Cost-effectiveness acceptability curves were constructed to represent uncertainty around cost-effectiveness. Results Rehabilitation (regardless of whether Indiv-rehab or Grp-rehab) cost £224/person (CI £184 to £262) more than usual primary care. The probability of rehabilitation being more cost-effective than usual primary care is 90% if decision-makers are willing to pay £1900 for functioning improvements. Indiv-rehab cost £314/person and Grp-rehab £125/person. Indiv-rehab cost £189 (CI 168 to £208) more per person than Grp-rehab. The probability of Indiv-rehab being more cost-effective than Grp-rehab increases as WTP increases, reaching 50% probability at WTP of £5500. The lack of differences in QALYs across the arms led to lower probabilities of cost-effectiveness based on this outcome. Conclusions Provision of ESCAPE-knee pain had small cost implications, but it was more likely to be cost-effective in improving function than usual primary care. Group rehabilitation reduces costs without compromising clinical effectiveness, increasing probability of cost-effectiveness.

AB - Background Expenditure on chronic knee pain is great and increasing. ESCAPE-knee pain is a safe, effective rehabilitation programme designed to improve functioning, but when planning provision of healthcare commissioners also require cost and cost-effectiveness evidence. This report details the economic evaluation of ESCAPE-knee pain. Methods Alongside a clinical trial, we estimated the costs of usual primary care and participation on ESCAPE-knee pain delivered to individuals (Indiv-rehab) or in groups of 8 participants (Grp-rehab). Resource use and informal care received were collected during face-to-face interviews. Cost-effectiveness and cost-utility were assessed from between-group differences in costs, function (primary clinical outcome) and quality-adjusted life years (QALYs). Cost-effectiveness acceptability curves were constructed to represent uncertainty around cost-effectiveness. Results Rehabilitation (regardless of whether Indiv-rehab or Grp-rehab) cost £224/person (CI £184 to £262) more than usual primary care. The probability of rehabilitation being more cost-effective than usual primary care is 90% if decision-makers are willing to pay £1900 for functioning improvements. Indiv-rehab cost £314/person and Grp-rehab £125/person. Indiv-rehab cost £189 (CI 168 to £208) more per person than Grp-rehab. The probability of Indiv-rehab being more cost-effective than Grp-rehab increases as WTP increases, reaching 50% probability at WTP of £5500. The lack of differences in QALYs across the arms led to lower probabilities of cost-effectiveness based on this outcome. Conclusions Provision of ESCAPE-knee pain had small cost implications, but it was more likely to be cost-effective in improving function than usual primary care. Group rehabilitation reduces costs without compromising clinical effectiveness, increasing probability of cost-effectiveness.

U2 - 10.1002/art.23011

DO - 10.1002/art.23011

M3 - Article

VL - 57

SP - 1220

EP - 1229

JO - ARTHRITIS CARE AND RESEARCH

JF - ARTHRITIS CARE AND RESEARCH

IS - 7

ER -