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

Arthritis Rheum. 2007 Oct 15;57(7):1220-9. doi: 10.1002/art.23011.


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 pounds (95% confidence interval [95% CI] 184 pounds, 262 pounds) 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 pounds for improvements in functioning. Indiv-rehab cost 314 pounds/person and Grp-rehab 125 pounds/person. Indiv-rehab cost 189 pounds (95% CI 168 pounds, 208 pounds) 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 pounds. 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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Exercise Therapy / economics*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / economics*
  • Osteoarthritis, Knee / physiopathology
  • Osteoarthritis, Knee / rehabilitation
  • Pain / etiology
  • Pain / prevention & control*
  • Primary Health Care / economics
  • Quality-Adjusted Life Years
  • Self Care / economics*
  • United Kingdom

Associated data

  • ISRCTN/ISRCTN94658828