Review
Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review

https://doi.org/10.1016/j.joca.2020.10.002Get rights and content
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Summary

Objective

To identify research gaps and inform implementation we systematically reviewed the literature evaluating cost-effectiveness of recommended treatments (education, exercise and diet) for the management of hip and/or knee OA.

Methods

We searched Medline, Embase, Cochrane Central Register of Controlled Trials, National Health Services Economic Evaluation Database, and EconLit from inception to November 2019 for trial-based economic evaluations investigating hip and/or knee OA core treatments. Two investigators screened relevant publications, extracted data and synthesized results. Risk of bias was assessed using the Consensus on Health Economic Criteria list.

Results

Two cost-minimization, five cost-effectiveness and 16 cost-utility analyses evaluated core treatments in six health systems. Exercise therapy with and without education or diet was cost-effective or cost-saving compared to education or physician-delivered usual care at conventional willingness to pay (WTP) thresholds in 15 out of 16 publications. Exercise interventions were cost-effective compared to physiotherapist-delivered usual care in three studies at conventional WTP thresholds. Education interventions were not cost-effective compared to usual care or placebo at conventional WTP thresholds in three out of four publications.

Conclusions

Structured core treatment programs were clinically effective and cost-effective, compared to physician-delivered usual care, in five health care systems. Providing education about core treatments was not consistently cost-effective. Implementing structured core treatment programs into funded clinical pathways would likely be an efficient use of health system resources and enhance physician-delivered usual primary care.

Keywords

Osteoarthritis
Hip
Knee
Education
Patient education
Health education
Exercise
Exercise therapy
Diet
Weight loss
Diet therapy
Cost-effectiveness analysis
Cost-utility analysis
Cost-benefit analysis
Economic evaluation

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PROSPERO Registration Number: CRD42020155964 (Accepted 28/04/2020) (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=155964).