Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain

AbstractObjective 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 A 224 (95 confidence interval [95 CI] A 184, A 262) 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 A 1,900 for improvements in functioning. Indiv-rehab cost A 314/person and Grp-rehab A 125/person. Indiv-rehab cost A 189 (95 CI A 168, A 208) 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 A 5,500. The lack of differences in QALYs across the arms led to lower probabilities of cost-effectiveness based on this outcome.Conclusion 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.