Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Cost-effectiveness of a blended physiotherapy intervention compared to usual physiotherapy in patients with hip and/or knee osteoarthritis: a cluster randomized controlled trial

Authors: Corelien J. J. Kloek, Johanna M. van Dongen, Dinny H. de Bakker, Daniël Bossen, Joost Dekker, Cindy Veenhof

Published in: BMC Public Health | Issue 1/2018

Login to get access

Abstract

Background

Blended physiotherapy, in which physiotherapy sessions and an online application are integrated, might support patients in taking an active role in the management of their chronic condition and may reduce disease related costs. The aim of this study was to evaluate the cost-effectiveness of a blended physiotherapy intervention (e-Exercise) compared to usual physiotherapy in patients with osteoarthritis of hip and/or knee, from the societal as well as the healthcare perspective.

Methods

This economic evaluation was conducted alongside a 12-month cluster randomized controlled trial, in which 108 patients received e-Exercise, consisting of physiotherapy sessions and a web-application, and 99 patients received usual physiotherapy. Clinical outcome measures were quality-adjusted life years (QALYs) according to the EuroQol (EQ-5D-3 L), physical functioning (HOOS/KOOS) and physical activity (Actigraph Accelerometer). Costs were measured using self-reported questionnaires. Missing data were multiply imputed and bootstrapping was used to estimate statistical uncertainty.

Results

Intervention costs and medication costs were significantly lower in e-Exercise compared to usual physiotherapy. Total societal costs and total healthcare costs did not significantly differ between groups. No significant differences in effectiveness were found between groups. For physical functioning and physical activity, the maximum probability of e-Exercise being cost-effective compared to usual physiotherapy was moderate (< 0.82) from both perspectives. For QALYs, the probability of e-Exercise being cost-effective compared to usual physiotherapy was 0.68/0.84 at a willingness to pay of 10,000 Euro and 0.70/0.80 at a willingness to pay of 80,000 Euro per gained QALY, from respectively the societal and the healthcare perspective.

Conclusions

E-Exercise itself was significantly cheaper compared to usual physiotherapy in patients with hip and/or knee osteoarthritis, but not cost-effective from the societal- as well as healthcare perspective. The decision between both interventions can be based on the preferences of the patient and the physiotherapist.

Trial registration

NTR4224 (25 October 2013).
Appendix
Available only for authorised users
Literature
1.
Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377(9783):2115–26.CrossRefPubMed
2.
3.
MMJ. N: Incidentie en prevalentie van gezondheidsproblemen in de Nederlandse huisartsenpraktijk in 2014. Uit: NIVEL Zorgregistraties eerste lijn [internet]. 2017 [Laatst gewijzigd op 23-02-2017; geraadpleegd op 03-05-2017]. URL: www.​nivel.​nl/​node/​4309. 2014.
4.
5.
McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–88.CrossRefPubMed
6.
Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Semin Arthritis Rheum. 2014;43(6):701–12.CrossRefPubMed
7.
Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. The Cochrane database of systematic reviews. 2015;1:CD004376.PubMed
8.
Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database of Syst Rev. 2014;4:CD007912.
9.
Elbert NJ, van Os-Medendorp H, van Renselaar W, Ekeland AG, Hakkaart-van Roijen L, Raat H, Nijsten TE, Pasmans SG. Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses. J Med Internet Res. 2014;16(4):e110.CrossRefPubMedPubMedCentral
10.
Wentzel J, van der Vaart R, Bohlmeijer ET, van Gemert-Pijnen JE. Mixing online and face-to-face therapy: how to benefit from blended Care in Mental Health Care. JMIR Mental Health. 2016;3(1):e9.CrossRefPubMedPubMedCentral
11.
Donker T, Blankers M, Hedman E, Ljotsson B, Petrie K, Christensen H. Economic evaluations of internet interventions for mental health: a systematic review. Psychol Med. 2015;45(16):3357–76.CrossRefPubMed
12.
Kraal JJ, Van den Akker-van Marle ME, Abu-Hanna A, Stut W, Peek N, Kemps HM. Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, Centre-based cardiac rehabilitation: results of the FIT@home study. Eur J Prev Cardiol. 2017:2047487317710803.
13.
Bossen D, Kloek C, Snippe HW, Dekker J, de Bakker D, Veenhof C. A blended intervention for patients with knee and hip osteoarthritis in the physical therapy practice: development and a pilot study. JMIR Res Prot. 2016;5(1):e32.CrossRef
14.
Kloek C, Bossen D, Spreeuwenberg P, Dekker J, de Bakker D, Veenhof C. Effectiveness of a blended physical therapist intervention in people with hip osteoarthritis, knee Osteoarthritis, or both: A Cluster-Randomized controlled trial. Phys Ther. 2018;98(7):560–70. https://​doi.​org/​10.​1093/​ptj/​pzy045.
15.
Kloek CJ, Bossen D, Veenhof C, van Dongen JM, Dekker J, de Bakker DH. Effectiveness and cost-effectiveness of a blended exercise intervention for patients with hip and/or knee osteoarthritis: study protocol of a randomized controlled trial. BMC Musculoskelet Disord. 2014;15:269.CrossRefPubMedPubMedCentral
16.
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039–49.CrossRefPubMed
17.
Peter WFH JM, Bloo H, Dekker-Bakker LMMCJ, Dilling RG, Hilberdink WKHA, Kersten-Smit C, de Rooij M, Veenhof C, Vermeulen HM, de Vos I, Vlieland TPMV. 2010.: KNGF-richtlijn Artrose heup-knie. Ned Tijdschr voor Fysiotherapie. 2010;(Suppl):1–23.
18.
EuroQol-group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRef
19.
Lamers LMSP, McDonnell J, Krabbe PFM, van Busschbach JJ. Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff. Ned Tijdschr Geneeskd. 2005;149:1574–8.PubMed
20.
Glick H. Economic evaluation in clinical trials. Oxford. New York: Oxford University Press; 2007.
21.
de Groot IB, Favejee MM, Reijman M, Verhaar JA, Terwee CB. The Dutch version of the knee injury and osteoarthritis outcome score: a validation study. Health Qual Life Outcomes. 2008;6:16.CrossRefPubMedPubMedCentral
22.
de Groot IB, Reijman M, Terwee CB, Bierma-Zeinstra SM, Favejee M, Roos EM, Verhaar JA. Validation of the Dutch version of the hip disability and osteoarthritis outcome score. Osteoarthr Cartil. 2007;15(1):104–9.CrossRefPubMed
23.
Hart TL, Swartz AM, Cashin SE, Strath SJ. How many days of monitoring predict physical activity and sedentary behaviour in older adults? Int J Behav Nutr Phys Act. 2011;8:62.CrossRefPubMedPubMedCentral
24.
Freedson PS, Melanson E, Sirard J. Calibration of the computer science and applications, Inc. accelerometer. Med Sci Sports Exerc. 1998;30(5):777–81.CrossRefPubMed
25.
26.
Hakkaart-van Roijen LvdL N, Bouwmans C, Kanters T, Tan SS: Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg. Diemen: CVZ; 2015.
27.
28.
Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14(2):171–89.CrossRefPubMed
29.
Kessler RC, Ames M, Hymel PA, Loeppke R, McKenas DK, Richling DE, Stang PE, Ustun TB. Using the World Health Organization health and work performance questionnaire (HPQ) to evaluate the indirect workplace costs of illness. J Occup Environ Med. 2004;46(6 Suppl):S23–37.CrossRefPubMed
30.
Kessler RC, Barber C, Beck A, Berglund P, Cleary PD, McKenas D, Pronk N, Simon G, Stang P, Ustun TB, et al. The World Health Organization health and work performance questionnaire (HPQ). J Occup Environ Med. 2003;45(2):156–74.CrossRefPubMed
31.
MW KM, Evers S, Severens J, Burdorf A, Brouwer W. Handleiding Voor Het Gebruik van PRODISQ Versie 2.1 [Manual for the Use of PRODISQ Version 2.1]. In: Erasmus MC Rotterdam: Instituut voor Medical Technology Assessment, Instituut Maatschappelijke Gezondheidszorg, Universiteit van Maastricht – Beleid Economie en Organisatie van de Zorg; 2004.
32.
Koopmanschap MA. PRODISQ: a modular questionnaire on productivity and disease for economic evaluation studies. Expert Rev Pharmacoecon Outcomes Res. 2005;5(1):23–8.CrossRefPubMed
33.
White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.CrossRefPubMed
34.
Gomes M, Ng ES, Grieve R, Nixon R, Carpenter J, Thompson SG. Developing appropriate methods for cost-effectiveness analysis of cluster randomized trials. Med Decis Mak. 2012;32(2):350–61.CrossRef
35.
Nixon RM, Wonderling D, Grieve RD. Non-parametric methods for cost-effectiveness analysis: the central limit theorem and the bootstrap compared. Health Econ. 2010;19(3):316–33.CrossRefPubMed
36.
de Vries HJ, Kloek CJJ, de Bakker DH, Dekker J, Bossen D, Veenhof C. Determinants of adherence to the online component of a blended intervention for patients with hip and/or knee osteoarthritis: a mixed methods study embedded in the e-exercise trial. Telemed J E Health. 2017;
37.
38.
Pinto D, Robertson MC, Hansen P, Abbott JH. Cost-effectiveness of nonpharmacologic, nonsurgical interventions for hip and/or knee osteoarthritis: systematic review. Value Health. 2012;15(1):1–12.CrossRefPubMed
39.
Tan SS, Teirlinck CH, Dekker J, Goossens LM, Bohnen AM, Verhaar JA, van Es PP, Koes BW, Bierma-Zeinstra SM, Luijsterburg PA, et al. Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care. Osteoarthr Cartil. 2016;24(4):581–8.CrossRefPubMed
Metadata
Title
Cost-effectiveness of a blended physiotherapy intervention compared to usual physiotherapy in patients with hip and/or knee osteoarthritis: a cluster randomized controlled trial
Authors
Corelien J. J. Kloek
Johanna M. van Dongen
Dinny H. de Bakker
Daniël Bossen
Joost Dekker
Cindy Veenhof
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5975-7

Other articles of this Issue 1/2018

BMC Public Health 1/2018 Go to the issue

Research article

The effects of public health policies on health inequalities in high-income countries: an umbrella review

Research article

Cost-effectiveness of a complex intervention to reduce children’s exposure to second-hand smoke in the home

Research article

Evaluation of the effectiveness of a WHO-5A model based comprehensive tobacco control program among migrant workers in Guangdong, China: a pilot study

Research article

Determinants of an integrated public health approach: the implementation process of Greenland’s second public health program

Research article

The impact of completing upper secondary education - a multi-state model for work, education and health in young men

Research article

Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England 2005–2015