IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0172749.html
   My bibliography  Save this article

Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee

Author

Listed:
  • Beth Woods
  • Andrea Manca
  • Helen Weatherly
  • Pedro Saramago
  • Eleftherios Sideris
  • Christina Giannopoulou
  • Stephen Rice
  • Mark Corbett
  • Andrew Vickers
  • Matthew Bowes
  • Hugh MacPherson
  • Mark Sculpher

Abstract

Background: There is limited information on the costs and benefits of alternative adjunct non-pharmacological treatments for knee osteoarthritis and little guidance on which should be prioritised for commissioning within the NHS. This study estimates the costs and benefits of acupuncture, braces, heat treatment, insoles, interferential therapy, laser/light therapy, manual therapy, neuromuscular electrical stimulation, pulsed electrical stimulation, pulsed electromagnetic fields, static magnets and transcutaneous electrical nerve Stimulation (TENS), based on all relevant data, to facilitate a more complete assessment of value. Methods: Data from 88 randomised controlled trials including 7,507 patients were obtained from a systematic review. The studies reported a wide range of outcomes. These were converted into EQ-5D index values using prediction models, and synthesised using network meta-analysis. Analyses were conducted including firstly all trials and secondly only trials with low risk of selection bias. Resource use was estimated from trials, expert opinion and the literature. A decision analytic model synthesised all evidence to assess interventions over a typical treatment period (constant benefit over eight weeks or linear increase in effect over weeks zero to eight and dissipation over weeks eight to 16). Results: When all trials are considered, TENS is cost-effective at thresholds of £20–30,000 per QALY with an incremental cost-effectiveness ratio of £2,690 per QALY vs. usual care. When trials with a low risk of selection bias are considered, acupuncture is cost-effective with an incremental cost-effectiveness ratio of £13,502 per QALY vs. TENS. The results of the analysis were sensitive to varying the intensity, with which interventions were delivered, and the magnitude and duration of intervention effects on EQ-5D. Conclusions: Using the £20,000 per QALY NICE threshold results in TENS being cost-effective if all trials are considered. If only higher quality trials are considered, acupuncture is cost-effective at this threshold, and thresholds down to £14,000 per QALY.

Suggested Citation

  • Beth Woods & Andrea Manca & Helen Weatherly & Pedro Saramago & Eleftherios Sideris & Christina Giannopoulou & Stephen Rice & Mark Corbett & Andrew Vickers & Matthew Bowes & Hugh MacPherson & Mark Scul, 2017. "Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-18, March.
    • Handle: RePEc:plo:pone00:0172749
    DOI: 10.1371/journal.pone.0172749
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172749
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0172749&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0172749?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Rowen, D & Brazier, J & Roberts, J, 2008. "Mapping SF-36 onto the EQ-5D index: how reliable is the relationship?," MPRA Paper 29831, University Library of Munich, Germany.
    2. Sofia Dias & Alex J. Sutton & Nicky J. Welton & A. E. Ades, 2013. "Evidence Synthesis for Decision Making 3," Medical Decision Making, , vol. 33(5), pages 618-640, July.
    3. Sofia Dias & Nicky J. Welton & Alex J. Sutton & A. E. Ades, 2013. "Evidence Synthesis for Decision Making 5," Medical Decision Making, , vol. 33(5), pages 657-670, July.
    4. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    5. Claxton, Karl, 1999. "The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies," Journal of Health Economics, Elsevier, vol. 18(3), pages 341-364, June.
    6. Alastair M. Gray & Oliver Rivero-Arias & Philip M. Clarke, 2006. "Estimating the Association between SF-12 Responses and EQ-5D Utility Values by Response Mapping," Medical Decision Making, , vol. 26(1), pages 18-29, January.
    7. Ning Gu & Chris Bell & Marc Botteman & Xiang Ji & John Carter & Ben Hout, 2012. "Estimating Preference-Based EQ-5D Health State Utilities or Item Responses from Neuropathic Pain Scores," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 5(3), pages 185-197, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Konstantinos Katsanos & Panagiotis Kitrou & Stavros Spiliopoulos & Ioannis Maroulis & Theodore Petsas & Dimitris Karnabatidis, 2017. "Comparative effectiveness of different transarterial embolization therapies alone or in combination with local ablative or adjuvant systemic treatments for unresectable hepatocellular carcinoma: A net," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-31, September.
    2. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    3. Ning Gu & Chris Bell & Marc Botteman & Xiang Ji & John Carter & Ben Hout, 2012. "Estimating Preference-Based EQ-5D Health State Utilities or Item Responses from Neuropathic Pain Scores," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 5(3), pages 185-197, September.
    4. Charles F. Manski, 2018. "Reasonable patient care under uncertainty," Health Economics, John Wiley & Sons, Ltd., vol. 27(10), pages 1397-1421, October.
    5. Andrija S Grustam & Nasuh Buyukkaramikli & Ron Koymans & Hubertus J M Vrijhoef & Johan L Severens, 2019. "Value of information analysis in telehealth for chronic heart failure management," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-23, June.
    6. Kasper M. Johannesen & Karl Claxton & Mark J. Sculpher & Allan J. Wailoo, 2018. "How to design the cost‐effectiveness appraisal process of new healthcare technologies to maximise population health: A conceptual framework," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 41-54, February.
    7. Oliver Rivero-Arias & Melissa Ouellet & Alastair Gray & Jane Wolstenholme & Peter M. Rothwell & Ramon Luengo-Fernandez, 2010. "Mapping the Modified Rankin Scale (mRS) Measurement into the Generic EuroQol (EQ-5D) Health Outcome," Medical Decision Making, , vol. 30(3), pages 341-354, May.
    8. Laura M Sawyer & Kinga Malottki & Celia Sabry-Grant & Najeeda Yasmeen & Emily Wright & Anne Sohrt & Emma Borg & Richard B Warren, 2019. "Assessing the relative efficacy of interleukin-17 and interleukin-23 targeted treatments for moderate-to-severe plaque psoriasis: A systematic review and network meta-analysis of PASI response," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-31, August.
    9. Konstantinos Katsanos & Stavros Spiliopoulos & Prakash Saha & Athanasios Diamantopoulos & Narayan Karunanithy & Miltiadis Krokidis & Bijan Modarai & Dimitris Karnabatidis, 2015. "Comparative Efficacy and Safety of Different Antiplatelet Agents for Prevention of Major Cardiovascular Events and Leg Amputations in Patients with Peripheral Arterial Disease: A Systematic Review and," PLOS ONE, Public Library of Science, vol. 10(8), pages 1-19, August.
    10. Wei Ding & Yulin Tan & Yan Qian & Wenbo Xue & Yibo Wang & Peng Jiang & Xuezhong Xu, 2020. "First-line targ veted therapies of advanced hepatocellular carcinoma: A Bayesian network analysis of randomized controlled trials," PLOS ONE, Public Library of Science, vol. 15(3), pages 1-19, March.
    11. Daniel Howdon & Sebastian Hinde & James Lomas & Matthew Franklin, 2022. "Economic Evaluation Evidence for Resource-Allocation Decision Making: Bridging the Gap for Local Decision Makers Using English Case Studies," Applied Health Economics and Health Policy, Springer, vol. 20(6), pages 783-792, November.
    12. Tracey A. Young & Clara Mukuria & Donna Rowen & John E. Brazier & Louise Longworth, 2015. "Mapping Functions in Health-Related Quality of Life," Medical Decision Making, , vol. 35(7), pages 912-926, October.
    13. John Brazier & Yaling Yang & Aki Tsuchiya & Donna Rowen, 2010. "A review of studies mapping (or cross walking) non-preference based measures of health to generic preference-based measures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(2), pages 215-225, April.
    14. Sarah Donegan & Lisa Williams & Sofia Dias & Catrin Tudur-Smith & Nicky Welton, 2015. "Exploring Treatment by Covariate Interactions Using Subgroup Analysis and Meta-Regression in Cochrane Reviews: A Review of Recent Practice," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-17, June.
    15. Philip Greengard & Andrew Gelman & Aki Vehtari, 2022. "A fast regression via SVD and marginalization," Computational Statistics, Springer, vol. 37(2), pages 701-720, April.
    16. Stefanie Reken & Sibylle Sturtz & Corinna Kiefer & Yvonne-Beatrice Böhler & Beate Wieseler, 2016. "Assumptions of Mixed Treatment Comparisons in Health Technology Assessments - Challenges and Possible Steps for Practical Application," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-16, August.
    17. Mohamed A. Hassan & Wenxi Liu & Daniel J. McDonough & Xiwen Su & Zan Gao, 2022. "Comparative Effectiveness of Physical Activity Intervention Programs on Motor Skills in Children and Adolescents: A Systematic Review and Network Meta-Analysis," IJERPH, MDPI, vol. 19(19), pages 1-12, September.
    18. Irina Pokhilenko & Luca M. M. Janssen & Aggie T. G. Paulus & Ruben M. W. A. Drost & William Hollingworth & Joanna C. Thorn & Sian Noble & Judit Simon & Claudia Fischer & Susanne Mayer & Luis Salvador-, 2023. "Development of an Instrument for the Assessment of Health-Related Multi-sectoral Resource Use in Europe: The PECUNIA RUM," Applied Health Economics and Health Policy, Springer, vol. 21(2), pages 155-166, March.
    19. Chiranjeev Sanyal & Don Husereau, 2020. "Systematic Review of Economic Evaluations of Services Provided by Community Pharmacists," Applied Health Economics and Health Policy, Springer, vol. 18(3), pages 375-392, June.
    20. Mark Oppe & Daniela Ortín-Sulbarán & Carlos Vila Silván & Anabel Estévez-Carrillo & Juan M. Ramos-Goñi, 2021. "Cost-effectiveness of adding Sativex® spray to spasticity care in Belgium: using bootstrapping instead of Monte Carlo simulation for probabilistic sensitivity analyses," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 711-721, July.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0172749. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.