Session Title: Rehabilitation Sciences
Session Type: Abstract Submissions (ARHP)
Background/Purpose: Management of chronic knee pain incurs enormous direct and indirect healthcare costs. Enabling Self-management and Coping with Arthritic knee Pain through Exercise (ESCAPE-knee pain) is an integrated rehabilitation programme that, in the short term at least, is more clinically and cost-effectiveness than usual primary care. Unfortunately, the long term costs and cost-effectiveness of the programme is unknown and need to be evaluated. We continued to follow ESCAPE-knee pain participants for 2½ years after completing the programme, to establish the long term knee pain-related costs and cost-effectiveness of the programme.
Methods: 418 participants were randomised to remain on usual primary care or receive the ESCAPE-knee pain programme (individually or groups of 8 participants). Physical function (using WOMAC function sub-score) and knee pain-related health and personal costs (using Client Services Resources Inventory) were assessed at regular time points for 2½ years after completing the programme.
Missing data were imputed using multiple imputation. Mean differences in total cost (95% confidence interval) were obtained from non-parametric bootstrapped linear regression (1000 replications). Costs were estimated from a health and social care perspective in 2003/2004 prices. Costs were discounted at 3.5%.
Cost-effectiveness acceptability curves (CEAC) estimated the probability ESCAPE-knee pain had of greater net monetary benefit compared with usual care, over a range of monetary values a healthcare provider might be prepared to pay for a sustained, clinically meaningful, improvement in function (defined as ≥15% increase from baseline WOMAC-function score) after 2½ years.
Results: 250 participants (60%) were followed-up for 2½ years. Participating on ESCAPE-knee pain cost £224/person (£184-£262). Compared to those who remained on usual care, 2½ years after completing the ESCAPE-knee pain programme a significantly higher proportion (+14%) of participants maintained clinically meaningful improvement in function, and lower health and social care costs. CEAC showed there was a high probability (80-100%) ESCAPE-knee pain was more cost-effective than usual care in producing sustained clinically meaningful improvement in function.
Conclusion: ESCAPE-knee pain is a low-cost intervention with sustained clinical and economic benefits compared to than usual primary care. These conclusions need to be considered given the trial’s high attrition rate and low power. Attrition rates are always high in trials with long term follow-up, and economic outcomes are rarely, if ever, used to power studies. Moreover, given that large-scale, long-term trials are very expensive and complex, few similar studies will be performed and will suffer similar limitations. These results, therefore, are a good estimation of long term clinical and economic outcomes, and contribute to the pool of data from other trials of this chronic condition.
D. N. E. Walsh,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-costs-and-cost-effectiveness-of-an-integrated-rehabilitation-programme-for-chronic-knee-pain/