TY - JOUR
T1 - How do the costs of physical therapy and arthroscopic partial meniscectomy compare?
T2 - A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study
AU - van de Graaf, Victor A
AU - van Dongen, Johanna M
AU - Willigenburg, Nienke W
AU - Noorduyn, Julia C A
AU - Butter, Ise K
AU - de Gast, Arthur
AU - Saris, Daniel B F
AU - van Tulder, Maurits W
AU - Poolman, Rudolf W
N1 - Funding Information:
Funding This study was funded by the Netherlands Organisation for Health Research and Development (in Dutch: ZonMw; grant number 837002009), Zilverenkruis Health Insurance (grant number Z436) and the foundation of medical research of the OLVG, Amsterdam (grant number 15u.025).
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/5
Y1 - 2020/5
N2 - OBJECTIVES: To examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a societal perspective. In a secondary analysis-this paper-we examined whether PT is non-inferior to APM.METHODS: We recruited patients aged 45-70 years with a non-obstructive meniscal tear in nine Dutch hospitals. Resource use was measured using web-based questionnaires. Measures of effectiveness included knee function using the International Knee Documentation Committee (IKDC) and quality-adjusted life-years (QALYs). Follow-up was 24 months. Uncertainty was assessed using bootstrapping techniques. The non-inferiority margins for societal costs, the IKDC and QALYs, were €670, 8 points and 0.057 points, respectively.RESULTS: We randomly assigned 321 patients to PT (n=162) or APM (n=159). PT was associated with significantly lower costs after 24 months compared with APM (-€1803; 95% CI -€3008 to -€838). The probability of PT being cost-effective compared with APM was 1.00 at a willingness to pay of €0/unit of effect for the IKDC (knee function) and QALYs (quality of life) and decreased with increasing values of willingness to pay. The probability that PT is non-inferior to APM was 0.97 for all non-inferiority margins for the IKDC and 0.89 for QALYs.CONCLUSIONS: The probability of PT being cost-effective compared with APM was relatively high at reasonable values of willingness to pay for the IKDC and QALYs. Also, PT had a relatively high probability of being non-inferior to APM for both outcomes. This warrants further deimplementation of APM in patients with non-obstructive meniscal tears.TRIAL REGISTRATION NUMBERS: NCT01850719 and NTR3908.
AB - OBJECTIVES: To examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a societal perspective. In a secondary analysis-this paper-we examined whether PT is non-inferior to APM.METHODS: We recruited patients aged 45-70 years with a non-obstructive meniscal tear in nine Dutch hospitals. Resource use was measured using web-based questionnaires. Measures of effectiveness included knee function using the International Knee Documentation Committee (IKDC) and quality-adjusted life-years (QALYs). Follow-up was 24 months. Uncertainty was assessed using bootstrapping techniques. The non-inferiority margins for societal costs, the IKDC and QALYs, were €670, 8 points and 0.057 points, respectively.RESULTS: We randomly assigned 321 patients to PT (n=162) or APM (n=159). PT was associated with significantly lower costs after 24 months compared with APM (-€1803; 95% CI -€3008 to -€838). The probability of PT being cost-effective compared with APM was 1.00 at a willingness to pay of €0/unit of effect for the IKDC (knee function) and QALYs (quality of life) and decreased with increasing values of willingness to pay. The probability that PT is non-inferior to APM was 0.97 for all non-inferiority margins for the IKDC and 0.89 for QALYs.CONCLUSIONS: The probability of PT being cost-effective compared with APM was relatively high at reasonable values of willingness to pay for the IKDC and QALYs. Also, PT had a relatively high probability of being non-inferior to APM for both outcomes. This warrants further deimplementation of APM in patients with non-obstructive meniscal tears.TRIAL REGISTRATION NUMBERS: NCT01850719 and NTR3908.
KW - Adult
KW - Aged
KW - Arthroscopy/economics
KW - Cost-Benefit Analysis
KW - Equivalence Trials as Topic
KW - Female
KW - Follow-Up Studies
KW - Health Care Costs
KW - Humans
KW - Male
KW - Meniscectomy/economics
KW - Middle Aged
KW - Physical Therapy Modalities/economics
KW - Tibial Meniscus Injuries/surgery
UR - http://www.scopus.com/inward/record.url?scp=85068003623&partnerID=8YFLogxK
U2 - 10.1136/bjsports-2018-100065
DO - 10.1136/bjsports-2018-100065
M3 - Article
C2 - 31227493
SN - 0306-3674
VL - 54
SP - 538
EP - 546
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 9
ER -