Exercise, Manual Therapy, and Booster Sessions in Knee Osteoarthritis: Cost-Effectiveness Analysis From a Multicenter Randomized Controlled Trial.
Allyn M Bove, Kenneth J Smith, Christopher G Bise and 5 others
PMID 29088393WHAT IT FOUND
Distributing physical therapy visits over 12 months with periodic booster sessions was more cost-effective than delivering all sessions within 9 weeks.
Strategies without boosters were dominated, meaning they cost more and provided less benefit.
Key findings
01Strategies that did not contain booster sessions were dominated by booster strategies, meaning they had higher costs and lower effectiveness.
02The exercise plus booster strategy gained 0.08 quality-adjusted life years while costing an additional $1,062 compared to the exercise, manual therapy, and booster strategy, resulting in an incremental cost-effectiveness ratio of $12,900 per quality-adjusted life year.
03In the probabilistic sensitivity analysis, the exercise plus booster strategy was favored in approximately 60% and 63% of model iterations at willingness-to-pay thresholds of $50,000 and $100,000 per quality-adjusted life year, respectively.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The analysis did not include a usual care group, so it cannot compare these structured strategies against standard non-therapy care. The number of total knee arthroplasties was small, limiting the power to detect differences in surgical outcomes between the groups. Costs for health care utilization were largely based on participant self-report, which is subject to recall bias. The 5-year projection assumed that transition probabilities observed in years 1 and 2 remained constant, which may not reflect the natural progression of osteoarthritis.
Declared interests
The study was supported by a grant from the Agency for Healthcare Research and Quality. The sponsors did not play a role in study design, data collection, analysis, interpretation, or manuscript preparation.
The easy way to misread this
Do not interpret this as evidence that adding manual therapy to a booster program is necessary for cost-effectiveness. The analysis found that the exercise plus booster strategy (without manual therapy) was the most effective and cost-efficient option, while strategies containing manual therapy were either dominated or less favored.