Economic evaluation of multidisciplinary rehabilitation after primary total knee arthroplasty based on a randomized controlled trial.

OBJECTIVE

To conduct an economic evaluation of a multidisciplinary, biopsychosocial outpatient rehabilitation program implemented 2-4 months after total knee arthroplasty (TKA), compared with conventional orthopedic care.

METHODS

After surgery, 86 patients were randomized to a multidisciplinary rehabilitation group (n = 44) or a conventional orthopedic care group (n = 42). Alongside the randomized controlled trial, we estimated the costs of rehabilitation, health care resource use, and community support. Information about resource use was collected by means of a questionnaire together with data from hospital records. The primary outcome (effectiveness) measure was change in self-reported functional capacity and the secondary measure was quality-adjusted life years (QALYs) gained during the 12-month followup. Cost-effectiveness was assessed from between-group differences in costs, change in functional capacity, and QALYs gained.

RESULTS

Both protocols of providing rehabilitation services turned out to be equally effective, but the conventional orthopedic care protocol was unequivocally cost saving: the saving was €1,830 per patient (95% confidence interval -548, 3,623) using the available direct cost data.

CONCLUSION

Multidisciplinary rehabilitation for unselected osteoarthritis patients in the subacute period of recovery after TKA is not a cost-effective use of health care resources. Similar rehabilitation protocols cannot be recommended for clinical pathways of TKA in the future.