Abstract | Importance:
Physical therapy and glucocorticoid injections are initial treatment options for knee osteoarthritis, but available data indicate that most patients receive one or the other, suggesting they may be competing interventions. The initial cost difference for treatment can be substantial, with physical therapy often being more expensive at the outset, and cost-effectiveness analysis can aid patients and clinicians in making decisions. Objective: Design, Setting, and Participants: This economic evaluation is a secondary analysis of a randomized clinical trial performed from October 1, 2012, to May 4, 2017. Health economists were blinded to study outcomes and treatment allocation. A randomized sample of patients seen in primary care and physical therapy clinics with a radiographically confirmed diagnosis of knee osteoarthritis were evaluated from the clinical trial with 96.2% follow-up at 1 year. Interventions: Main Outcomes and Measures: The main outcome was incremental cost-effectiveness between 2 alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICERs) were used to identify the proportion of ICERs under the specific willingness-to-pay level ($50 000-$100 000). Health care system costs (total and knee related) and health-related quality-of-life based on quality-adjusted life-years (QALYs) were obtained. Results: A total of 156 participants (mean [SD] age, 56.1 [8.7] years; 81 [51.9%] male) were randomized 1:1 and followed up for 1 year. Mean (SD) 1-year knee-related medical costs were $2113 ($4224) in the glucocorticoid injection group and $2131 ($1015) in the physical therapy group. The mean difference in QALY significantly favored physical therapy at 1 year (0.076; 95% CI, 0.02-0.126; P = .003). Physical therapy was the more cost-effective intervention, with an ICER of $8103 for knee-related medical costs, with a 99.2% probability that results fall below the willingness-to-pay threshold of $100 000. Conclusions and Relevance: Trial Registration: ClinicalTrials.gov Identifier: NCT01427153.
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Authors | Daniel I Rhon, Minchul Kim, Carl V Asche, Stephen C Allison, Chris S Allen, Gail D Deyle |
Journal | JAMA network open
(JAMA Netw Open)
Vol. 5
Issue 1
Pg. e2142709
(01 04 2022)
ISSN: 2574-3805 [Electronic] United States |
PMID | 35072722
(Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
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Chemical References |
- Anti-Inflammatory Agents
- Glucocorticoids
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Topics |
- Anti-Inflammatory Agents
(administration & dosage, economics, therapeutic use)
- Cost-Benefit Analysis
- Female
- Glucocorticoids
(administration & dosage, economics, therapeutic use)
- Humans
- Injections, Intra-Articular
- Male
- Middle Aged
- Osteoarthritis, Knee
(economics, therapy)
- Physical Therapy Modalities
(economics, statistics & numerical data)
- Randomized Controlled Trials as Topic
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