Lifestyle interventions for knee pain in overweight and obese adults aged >=45: economic evaluation of randomised controlled trial

doi:10.1136/bmj.b2273

Published 18 August 2009, doi:10.1136/bmj.b2273
Cite this as: BMJ 2009;339:b2273

Research

Lifestyle interventions for knee pain in overweight and obese adults aged $≥$ 45: economic evaluation of randomised controlled trial

Garry R Barton, senior lecturer in health economics¹, Tracey H Sach, senior lecturer in health economics¹^,2^,3, Claire Jenkinson, research associate², Michael Doherty, professor of rheumatology⁴, Anthony J Avery, professor of primary care², Kenneth R Muir, professor of epidemiology²

¹ Health Economics Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, ² School of Community Health Sciences, University of Nottingham, Nottingham NG7 2RD, ³ School of Pharmacy, University of East Anglia, Norwich, ⁴ Academic Rheumatology, University of Nottingham, Nottingham

Correspondence to: T Sach, School of Pharmacy, University of East Anglia, Norwich NR4 7TJ T.Sach{at}uea.ac.uk

Objective To estimate the cost effectiveness of four differentlifestyle interventions for knee pain.

Design Cost utility analysis of randomised controlled trial.

Setting Five general practices in the United Kingdom.

Participants 389 adults aged $≥$ 45 with self reported knee painand body mass index (BMI) $≥$ 28.

Interventions Dietary intervention plus quadriceps strengtheningexercises, dietary intervention, quadriceps strengthening exercises,and leaflet provision. Participants received home visits overa two year period.

Main outcome measure Incremental cost per quality adjusted lifeyear (QALY) gained over two years from a health service perspective.

Results Advice leaflet was associated with a mean change incost of –£31, and a mean QALY gain of 0.085. Bothstrengthening exercises and dietary intervention were more effective(0.090 and 0.133 mean QALY gain, respectively) but were notcost effective. Dietary intervention plus strengthening exerciseshad a mean cost of £647 and a mean QALY gain of 0.147and was estimated to have an incremental cost of £10 469per QALY gain (relative to leaflet provision), and a 23.1% probabilityof being cost effective at a £20 000/QALY threshold.

Conclusion Dietary intervention plus strengthening exerciseswas estimated to be cost effective for individuals with kneepain, but with a large level of uncertainty.

Trial registration ISRCTN93206785 [controlled-trials.com] .

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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