Economic evaluation of a rehabilitation program integrating exercise, self‐management, and active coping strategies for chronic knee pain

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Abstract
Objective: To conduct an economic evaluation of the Enabling Self‐Management and Coping with Arthritic Knee Pain through Exercise (ESCAPE‐knee pain) program.Methods: Alongside a clinical trial, we estimated the costs of usual primary care and participation in ESCAPE‐knee pain delivered to individuals (Indiv‐rehab) or groups of 8 participants (Grp‐rehab). Information on resource use and informal care received was collected during face‐to‐face interviews. Cost‐effectiveness and cost‐utility were assessed from between‐group differences in costs, function (primary clinical outcome), and quality‐adjusted life years (QALYs). Cost‐effectiveness acceptability curves were constructed to represent uncertainty around cost‐effectiveness.Results: Rehabilitation (regardless of whether Indiv‐rehab or Grp‐rehab) cost £224 (95% confidence interval [95% CI] £184, £262) more per person than usual primary care. The probability of rehabilitation being more cost‐effective than usual primary care was 90% if decision makers were willing to pay £1,900 for improvements in functioning. Indiv‐rehab cost £314/person and Grp‐rehab £125/person. Indiv‐rehab cost £189 (95% CI £168, £208) more per person than Grp‐rehab. The probability of Indiv‐rehab being more cost‐effective than Grp‐rehab increased as willingness to pay (WTP) increased, reaching 50% probability at WTP £5,500. The lack of differences in QALYs across the arms led to lower probabilities of cost‐effectiveness based on this outcome.Conclusion: Provision of ESCAPE‐knee pain had small cost implications, but it was more likely to be cost‐effective in improving function than usual primary care. Group rehabilitation reduces costs without compromising clinical effectiveness, increasing probability of cost‐effectiveness.

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