Vetsch, Thomas; Taeymans, Jan; Lutz, Nathanael (2023). Optimising the current model of care for knee osteoarthritis with the implementation of guideline recommended non-surgical treatments: a model-based health economic evaluation Swiss Medical Weekly, 153(4), p. 40059. EMH Schweizerischer Aerzteverlag 10.57187/smw.2023.40059
|
Text
smw-153-40059.pdf - Published Version Available under License Creative Commons: Attribution (CC-BY). Download (5MB) | Preview |
AIMS OF THE STUDY: Structured exercise, education, weight management and painkiller prescription are guideline recommended non-surgical treatments for patients suffering from knee osteoarthritis. Despite its endorsement, uptake of guideline recommended non-surgical treatments remains low. It is unknown whether the implementation of these treatments into the current model of care for knee osteoarthritis would be cost-effective from a Swiss statutory healthcare perspective. We therefore aimed to (1) assess the incremental cost-effectiveness ratio of an optimised model of care incorporating guideline recommended non-surgical treatments in adults with knee osteoarthritis and (2) the effect of total knee replacement (TKR) delay with guideline recommended non-surgical treatments on the cost-effectiveness of the overall model of care. METHODS: A Markov model from the Swiss statutory healthcare perspective was used to compare an optimised model of care incorporating guideline recommended non-surgical treatments versus the current model of care without standardised guideline recommended non-surgical treatments. Costs were derived from two Swiss health insurers, a national database, and a reimbursement catalogue. Utility values and transition probabilities were extracted from clinical trials and national population data. The main outcome was the incremental cost-effectiveness ratio for three scenarios: “base case” (current model of care vs optimised model of care with no delay of total knee replacement), “two-year delay” (current model of care vs optimised model of care + two-year delay of total knee replacement) and “five-year delay” (current model of care vs optimised model of care + five-year delay of total knee replacement). Costs and utilities were discounted at 3% per year and a time horizon of 70 years was chosen. Probabilistic sensitivity analyses were conducted. RESULTS: The “base case” scenario led to 0.155 additional quality-adjusted life years (QALYs) per person at an additional cost per person of CHF 341 (ICER = CHF 2,203 / QALY gained). The “two-year delay” scenario led to 0.134 additional QALYs and CHF –14 cost per person. The “five-year delay” scenario led to 0.118 additional QALYs and CHF –501 cost per person. Delay of total knee replacement by two and five years led to an 18% and 36% reduction of revision surgeries, respectively, and had a cost-saving effect. CONCLUSION: According to this Markov model, the optimisation of the current model of care by implementing guideline recommended non-surgical treatments would likely be cost-effective from a statutory healthcare perspective. If implementing guideline recommended non-surgical treatments delays total knee replacement by two or five years, the amount of revision surgeries may be reduced.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
School of Health Professions School of Health Professions > Physiotherapy School of Health Professions > Physiotherapy > Public Health & Physiotherapy Related Health Economics |
Name: |
Vetsch, Thomas; Taeymans, Jan and Lutz, Nathanael  0000-0002-7512-7060 |
Subjects: |
R Medicine > R Medicine (General) R Medicine > RM Therapeutics. Pharmacology R Medicine > RZ Other systems of medicine |
ISSN: |
1424-3997 |
Publisher: |
EMH Schweizerischer Aerzteverlag |
Language: |
English |
Submitter: |
Nathanael Lutz |
Date Deposited: |
10 May 2023 08:36 |
Last Modified: |
10 May 2023 08:36 |
Publisher DOI: |
10.57187/smw.2023.40059 |
ARBOR DOI: |
10.24451/arbor.19180 |
URI: |
https://arbor.bfh.ch/id/eprint/19180 |
Actions (login required)
 |
View Item |