Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain.
OBJECTIVE
To conduct an economic evaluation of the Enabling Self-Management and Coping with Arthritic Knee Pain through Exercise (ESCAPE-knee pain) program.


METHODS
Alongside a clinical trial, we estimated the costs of usual primary care and participation in ESCAPE-knee pain delivered to individuals (Indiv-rehab) or groups of 8 participants (Grp-rehab). Information on resource use and informal care received was 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 pounds (95% confidence interval [95% CI] 184 pounds, 262 pounds) more per person than usual primary care. The probability of rehabilitation being more cost-effective than usual primary care was 90% if decision makers were willing to pay 1,900 pounds for improvements in functioning. Indiv-rehab cost 314 pounds/person and Grp-rehab 125 pounds/person. Indiv-rehab cost 189 pounds (95% CI 168 pounds, 208 pounds) more per person than Grp-rehab. The probability of Indiv-rehab being more cost-effective than Grp-rehab increased as willingness to pay (WTP) increased, reaching 50% probability at WTP 5,500 pounds. 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.
Hurley
M V
MV
King's College London, London, UK. mike.hurley@kcl.ac.uk
Walsh
N E
NE
Mitchell
H L
HL
Pimm
T J
TJ
Williamson
E
E
Jones
R H
RH
Reeves
B C
BC
Dieppe
P A
PA
Patel
A
A
D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000191:economics* / Q000503:physiopathology / Q000534:rehabilitation; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D011320:Primary Health Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics*; D006113:United Kingdom