Cost‐Effectiveness of Community‐Based Diet and Exercise for Patients with Knee Osteoarthritis and Obesity or Overweight

Mar 7, 2024Arthritis care & research

Cost-Effectiveness of Community Diet and Exercise Programs for Overweight People with Knee Osteoarthritis

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Abstract

The community-based diet and exercise program resulted in an additional 6 kg weight loss and 20% greater pain relief in individuals with knee osteoarthritis.

Usual care (UC) provides 9.36 quality-adjusted life years (QALYs) per person, while UC plus health education (HE) offers 9.44 QALYs, and UC plus diet and exercise (D + E) yields 9.49 QALYs.
Lifetime costs are $147,102 for UC, $148,139 for UC + HE, and $151,478 for UC + (D + E).
From a societal perspective, the incremental cost-effectiveness ratio (ICER) for UC + HE is $12,700 per QALY, while adding D + E results in an ICER of $61,700 per QALY.
The D + E program may be cost-effective at willingness-to-pay thresholds exceeding $62,000 per QALY.
These results indicate potential benefits of integrating community-based D + E programs into the care of individuals with knee osteoarthritis.

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OBJECTIVE: Obesity exacerbates pain and functional limitation in persons with knee osteoarthritis (OA). In the Weight Loss and Exercise for Communities with Arthritis in North Carolina (WE-CAN) study, a community-based diet and exercise (D + E) intervention led to an additional 6 kg weight loss and 20% greater pain relief in persons with knee OA and body mass index (BMI) >27 kg/mrelative to a group-based health education (HE) intervention. We sought to determine the incremental cost-effectiveness of the usual care (UC), UC + HE, and UC + (D + E) programs, comparing each strategy with the "next-best" strategy ranked by increasing lifetime cost. 2

METHODS: We used the Osteoarthritis Policy Model to project long-term clinical and economic benefits of the WE-CAN interventions. We considered three strategies: UC, UC + HE, and UC + (D + E). We derived cohort characteristics, weight, and pain reduction from the WE-CAN trial. Our outcomes included quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness ratios (ICERs).

RESULTS: In a cohort with mean age 65 years, BMI 37 kg/m, and Western Ontario and McMaster Universities Osteoarthritis Index pain score 38 (scale 0-100, 100 = worst), UC leads to 9.36 QALYs/person, compared with 9.44 QALYs for UC + HE and 9.49 QALYS for UC + (D + E). The corresponding lifetime costs are $147,102, $148,139, and $151,478. From the societal perspective, UC + HE leads to an ICER of $12,700/QALY; adding D + E to UC leads to an ICER of $61,700/QALY. 2

CONCLUSION: The community-based D + E program for persons with knee OA and BMI >27kg/mcould be cost-effective for willingness-to-pay thresholds greater than $62,000/QALY. These findings suggest that incorporation of community-based D + E programs into OA care may be beneficial for public health. 2

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Cost‐Effectiveness of Community‐Based Diet and Exercise for Patients with Knee Osteoarthritis and Obesity or Overweight

Abstract

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