Real-World Cost-Effectiveness of a Standardized Education and Exercise Therapy Program for Hip and Knee Osteoarthritis Compared to Usual Care

Abstract

Objective: We estimated the real-world cost-effectiveness of a standardized education and exercise therapy program (GLA:D) compared to usual care (UC) for people managing hip and/or knee osteoarthritis (HKOA). Methods: We used a prospective matched cohort design to recruit people (aged >45 years) diagnosed with HKOA who used GLA:D or UC (not on a surgical waitlist) throughout Alberta, Canada. Demographics, pain, function, quality of life, and an HKOA-related cost questionnaire were administered over 12 months. The primary Ministry of Health (MOH) perspective used administrative data to estimate all public health care costs. The secondary health care perspective included MOH, private insurance, and out-of-pocket costs. We calculated our cost-effectiveness measure, incremental net monetary benefit (INMB) in Canadian dollars, over 12 months with a $30,000/quality-adjusted life years (QALY) willingness to pay threshold and adjusted for the differences between cohorts. A Markov model was used to extend INMB over a lifetime time horizon (3% discounting). Model uncertainty was explored by probabilistic sensitivity analyses. Results: A total of 254 participants (GLA:D n = 127, UC n = 127; 72% female), with a mean age of 64.3 years (95% confidence interval [CI]: 63.1–65.5), diagnosed with knee osteoarthritis (63%), hip osteoarthritis (24%), or both (13%) were observed for a mean of 5.5 years (95% CI: 4.8–6.3). The adjusted INMB of GLA:D compared to UC was $6,065 (95% CI: $3,648–$8,482) and $499 (95% CI: −$2,913 to $3,912) from an MOH and health care perspective over 12 months and $6,574 and $1,775 over a lifetime with 54% and 51% probability of being cost-effective using a threshold of willingness to pay of $30,000 per QALY. Conclusions: GLA:D had a positive INMB compared to UC from the MOH perspective over 12 months. The INMB remained positive but was less certain over a lifetime or when out-of-pocket and private insurance costs were considered.