1Center for Health Equity Research and Promotion of the VA Pittsburgh Healthcare System, Pittsburgh, PA 15213, USA.
Med Sci Sports Exerc. 2009 Jun;41(6):1167-74. doi: 10.1249/MSS.0b013e318197ece7.
The purpose of this study was to compare the cost-effectiveness of dietary and exercise interventions in overweight or obese elderly patients with knee osteoarthritis (OA) enrolled in the Arthritis, Diet, and Physical Activity Promotion Trial (ADAPT).
ADAPT was a single-blinded, controlled trial of 316 adults with knee OA, randomized to one of four groups: Healthy Lifestyle Control group, Diet group, Exercise group, or Exercise and Diet group. A cost analysis was performed from a payer perspective, incorporating those costs and benefits that would be realized by a managed care organization interested in maintaining the health and satisfaction of its enrollees while reducing unnecessary utilization of health care services.
The Diet intervention was most cost-effective for reducing weight, at $35 for each percentage point reduction in baseline body weight. The Exercise intervention was most cost-effective for improving mobility, costing $10 for each percentage point improvement in a 6-min walking distance and $9 for each percentage point improvement in the timed stair climbing task. The Exercise and Diet intervention was most cost-effective for improving self-reported function and symptoms of arthritis, costing $24 for each percentage point improvement in subjective function, $20 for each percentage point improvement in self-reported pain, and $56 for each percentage point improvement in self-reported stiffness.
The Exercise and Diet intervention consistently yielded the greatest improvements in weight, physical performance, and symptoms of knee OA. However, it was also the most expensive and was the most cost-effective approach only for the subjective outcomes of knee OA (self-reported function, pain, and stiffness). Perceived function and symptoms of knee OA are likely to be stronger drivers of downstream health service utilization than weight, or objective performance measures and may be the most cost-effective in the long term.
本研究旨在比较饮食和运动干预措施在参加关节炎、饮食和体育活动促进试验（ADAPT）的超重或肥胖老年膝骨关节炎（OA）患者中的成本效益。
ADAPT 是一项针对 316 名膝骨关节炎患者的单盲对照试验，将其随机分为四组：健康生活方式对照组、饮食组、运动组或运动和饮食组。从支付者的角度进行成本分析，纳入管理式医疗组织感兴趣的那些成本和效益，该组织希望维持其参保人的健康和满意度，同时减少不必要的医疗服务利用。
饮食干预在降低体重方面最具成本效益，每降低基础体重的 1%，成本为 35 美元。运动干预在改善活动能力方面最具成本效益，每提高 6 分钟步行距离的 1%，成本为 10 美元，每提高登梯任务的 1%，成本为 9 美元。运动和饮食干预在改善自我报告的功能和关节炎症状方面最具成本效益，每提高主观功能的 1%，成本为 24 美元，每提高自我报告疼痛的 1%，成本为 20 美元，每提高自我报告僵硬的 1%，成本为 56 美元。
运动和饮食干预在体重、身体表现和膝骨关节炎症状方面始终能取得最大的改善。然而，它也是最昂贵的，仅对膝骨关节炎的主观结局（自我报告的功能、疼痛和僵硬）具有成本效益。与体重或客观表现测量相比，对膝骨关节炎的感知功能和症状可能是推动下游卫生服务利用的更强驱动力，从长期来看可能具有成本效益。
