SAT0556 Cost-effectiveness of a blended physiotherapy intervention in patients with hip and/or knee osteoarthritis: a cluster randomised controlled trial

Abstract

Background: Physiotherapy, consisting of education, graded activity and exercises, is effective in improving levels of physical functioning and pain in patients with osteoarthritis (OA) of hip and/or knee. Blended physiotherapy, in which physiotherapy sessions and an online application are integrated, might support patients in taking an active role in the management of their condition and may reduce disease related costs. Recently, the blended physiotherapy intervention e‐Exercise was developed. Bossen 2016 E‐Exercise is an integration of five face‐to‐face physiotherapy sessions with an online application consisting of information‐, exercise‐, and a graded activity module. Objectives: To evaluate the cost‐effectiveness of e‐Exercise compared to usual physiotherapy in patients with OA of hip and/or knee, from the societal as well as the healthcare perspective. Methods: This economic evaluation was conducted alongside a 12 month cluster randomised controlled trial, in which 108 patients received e‐Exercise and 99 patients received usual physiotherapy. Clinical outcome measures were qualityadjusted life years (QALYs) according to the EuroQol (EQ‐5D‐3L), physical functioning (HOOS/KOOS) and physical activity (Actigraph Accelerometer). Costs were measured using self‐reported questionnaires. Missing data were multiply imputed and bootstrapping was used to estimate statistical uncertainty. Results: Total societal costs and total healthcare costs did not significantly differ between groups. Intervention costs (DC C€ ‐202; 95% CI:‐286 tot ‐120) and medication costs (ΔC C€ ‐151; 95%:‐340 tot ‐52) were significantly lower in e‐Exercise compared to usual physiotherapy. No significant differences in effectiveness were found between groups (QALYS (0‐1): B=0.01; 95% CI: ‐0.03 till 0.04; HOOS/KOOS (0‐100): B=1.49; 95% CI: ‐4.70 till 0.69; Accelerometer (min/dag): B=‐3.46; 95% CI: ‐11.66 till 4.73). For physical functioning and physical activity, the maximum probability of e‐Exercise being cost‐effective compared to usual physiotherapy was moderate (<0.82) from both perspectives. For QALYs, the probability of e‐Exercise being cost‐effective compared to usual physiotherapy was 0.68/0.84 at a willingness to pay of C€ 10.000,‐and 0.70/0.80 at a willingness to pay of C€ 80.000,‐per gained QALY, from respectively the societal and the healthcare perspective. Conclusions: E‐Exercise itself was significantly cheaper compared to usual physiotherapy in patients with hip and/or knee OA, but not cost‐effective from the societal‐as well as healthcare perspective. The decision between both interventions can be based on the preferences of the patient and the physiotherapist.