Benefit of Booster Exercise for Patients with Knee Osteoarthritis

VBCR - December 2015, Volume 4, No 6 - Knee Osteoarthritis
Phoebe Starr

San Francisco, CA—Exercise is beneficial for patients with knee osteoarthritis (OA), but few studies have addressed which is the most beneficial and cost-effective strategy. Spacing exercise-based physical therapy over a 12-month period using 4 additional “booster” sessions periodically was the most cost-effective strategy among 4 strategies included in a study presented at the annual meeting of the American College of Rheumatology.1,2

“Booster sessions are not part of the typical clinical strategy and are not reimbursed by insurers. Our study suggests that implementing booster sessions several times a year could save money and at the same time improve management of knee OA. We would need to work with insurance companies and third-party payers to incorporate boosters into reimbursement compared to the way we currently get reimbursed for treatment of knee OA,” said lead author Allyn Bove, PT, DPT, Assistant Professor, Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, PA.

The study included combinations of physical exercise therapy, manual therapy, and booster sessions. “Evidence for manual therapy is varied but in general supports the use of mobilization and stretching provided by a physical therapist. Most of the evidence favors scheduled sessions, but some studies suggest that booster sessions may be helpful,” she explained.

The 2-year study enrolled 300 patients with knee OA who were randomized to 1 of 4 arms: (1) 12 visits of exercise therapy alone over a 9-week period; (2) 8 initial visits of physical exercise therapy within a 9-week period plus 4 booster sessions at 3 time points (2 at month 5 and 1 at months 8 and 11) spaced across a 12-month period; (3) 12 visits of exercise therapy plus manual therapy; and (4) 8 initial visits of exercise therapy plus manual therapy and 4 booster sessions.2 The booster strategies (#2 and #4) significantly lowered healthcare costs and had greater effectiveness in the treatment of patients with knee OA.

The authors determined cost-effectiveness by estimating quality adjusted life-years (QALYs), a metric that encompasses length of life and quality. Fifty thousand dollars to $100,000 would be considered cost-effective for 1 QALY, she said.

“One QALY could mean a person lived 1 year longer at 100% health or 2 years longer by 50% health,” she explained.

They also estimated the incremental cost-effectiveness ratio (ICER), a metric that takes the difference in cost divided by the effectiveness of the therapy.

At the end of 2 years, exercise, manual therapy, plus booster sessions (strategy #4) was the least costly but also had lower gains in QALYs compared with the exercise plus booster strategy (#2). Strategies without booster sessions (#1 and #3) were more expensive and less effective.

The exercise plus booster regimen cost $1061 more and gained 0.082 more QALYs compared with exercise plus manual therapy plus booster, for $12,900/QALY gained. In 1-way sensitivity analyses of all parameters, exercise plus booster continued to be cost-effective (ie, <$100,000/QALY gained) compared with exercise plus manual therapy plus booster.

A preliminary model projecting costs and utilities over a 5-year period showed that the exercise plus booster strategy remained within the range that third-party payers would consider to be cost-effective, she said.

“The clear choice that gives us the most QALYs is exercise plus boosters—$12,900 per QALY,” she said. “If we were unwilling to spend any more money, we could use the least expensive strategy: exercise plus manual therapy plus booster, but this strategy had lower gains in QALY than the exercise plus booster group.”

In the future, Ms Bove and colleagues plan to study which of these strategies can delay disease progression.

References

  1. Bove A, Smith K, Bise C, et al. What is the most cost-effective physical therapy strategy to treat knee osteoarthritis? Presented at: 2015 American College of Rheumatology Annual Meeting; November 7-11, 2015; San Francisco, CA. Abstract 1001.
  2. Effectiveness and cost-effectiveness of physical therapy for knee osteoarthritis [press release]. San Francisco, CA: American College of Rheumatology; November 9, 2015. www.rheumatology.org-About-Us/Newsroom/Press-Releases/ID/718/Effectiveness-and-Cost-Effectiveness-of-Physical-Therapy-for-Knee-Osteoarthritis. Accessed November 24, 2015.
Related Items
Tocilizumab Demonstrates Success in the Treatment of Patients with Giant Cell Arteritis
Phoebe Starr
VBCR - December 2016, Vol 5, No 6 published on January 5, 2017 in Giant Cell Arteritis
Rituximab Maintenance Outshines Azathioprine for Antineutrophil Cytoplasmic Autoantibody–Associated Vasculitis
Phoebe Starr
VBCR - December 2016, Vol 5, No 6 published on January 5, 2017 in Vasculitis
Cost of Drugs and Affordability Don’t Always Jibe
Phoebe Starr
VBCC - July 2016, Vol 7, No 6 published on July 13, 2016 in Value in Oncology
Usefulness of Vitamin D Supplementation Questioned in Patients with Knee Osteoarthritis
Phoebe Starr
VBCR - June 2016, Vol 5, No 3 published on July 7, 2016 in Osteoarthritis
Baricitinib Effective in Patients with Refractory Rheumatoid Arthritis
Phoebe Starr
VBCR - June 2016, Vol 5, No 3 published on July 7, 2016 in Rheumatoid Arthritis
Vaccine Uptake Remains Low in Patients with RA
Phoebe Starr
VBCR - June 2016, Vol 5, No 3 published on July 7, 2016 in Health & Wellness
Age, Smoking History Are Risk Factors for Early Organ Damage in Patients with SLE
Phoebe Starr
VBCR - June 2016, Vol 5, No 3 published on July 7, 2016 in Lupus
IL-6 Inhibitor Shows Promise in Patients with PsA
Phoebe Starr
VBCR - June 2016, Vol 5, No 3 published on July 7, 2016 in Psoriatic Arthritis
ESR1 Mutations Predict Worse Survival in ER-Positive Advanced Breast Cancer
Phoebe Starr
VBCC - June 2016, Vol 7, No 5 published on June 17, 2016 in Personalized Medicine
Early Results of Immunotherapy in Breast Cancer
Phoebe Starr
VBCC - June 2016, Vol 7, No 5 published on June 17, 2016 in Breast Cancer
Last modified: January 13, 2016
  • Rheumatology Practice Management
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology