Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
Osteoarthritis Cartilage. 2020 Jun;28(6):735-743. doi: 10.1016/j.joca.2020.01.017. Epub 2020 Mar 10.
Physical activity (PA) in the US knee osteoarthritis (OA) population is low, despite well-established health benefits. PA program implementation is often stymied by sustainability concerns. We sought to establish parameters that would make a short-term (3-year efficacy) PA program a cost-effective component of long-term OA care.
Using a validated computer microsimulation (Osteoarthritis Policy Model), we examined the long-term clinical (e.g., comorbidities averted), quality of life (QoL), and economic impacts of a 3-year PA program, based upon the SPARKS (Studying Physical Activity Rewards after Knee Surgery) Trial, for inactive knee OA patients. We determined the cost, efficacy, and impact of PA on QoL and medical costs that would make a PA program a cost-effective addition to OA care.
Among the 14 million with knee OA in the US, >4 million are inactive. Participation of 10% in the modeled PA program could save 200 cases of cardiovascular disease, 400 cases of diabetes, and 6,800 quality-adjusted life-years (QALYs). The program had an incremental cost-effectiveness ratio (ICER) of $16,100/QALY. Tripling PA program cost ($860/year) raised the ICER to $108,300/QALY; varying QoL benefits from PA yielded ICERs of $8,800/QALY-$99,900/QALY; varying background cost savings from PA did not qualitatively impact ICERs. Offering the PA program to any adults with knee OA (not only inactive) yielded $31,000/QALY.
A PA program with 3-year efficacy in the knee OA population carried favorable long-term clinical and economic benefits. These results offer justification for policymakers and payers considering a PA intervention incorporated into knee OA care.
尽管有明确的健康益处，但美国膝骨关节炎（OA）人群的身体活动（PA）水平较低。PA 项目的实施常常因可持续性问题而受阻。我们试图确定一些参数，以使短期（3 年疗效）PA 项目成为长期 OA 护理的一个具有成本效益的组成部分。
使用经过验证的计算机微观模拟（骨关节炎政策模型），我们根据 SPARKS（膝关节手术后研究体力活动奖励）试验，研究了 3 年 PA 计划对不活跃的膝 OA 患者的长期临床（例如，预防的合并症）、生活质量（QoL）和经济影响。我们确定了使 PA 计划成为 OA 护理的具有成本效益的附加项所需的 PA 对 QoL 和医疗成本的成本、疗效和影响。
在美国的 1400 万膝 OA 患者中，有超过 400 万人不活跃。在模拟的 PA 计划中，有 10%的人参与，可预防 200 例心血管疾病、400 例糖尿病和 6800 个质量调整生命年（QALYs）。该计划的增量成本效益比（ICER）为 16100 美元/QALY。将 PA 计划的成本增加两倍（每年 860 美元），将 ICER 提高到 108300 美元/QALY；PA 带来的 QoL 效益变化产生的 ICER 值为 8800 美元/QALY-99900 美元/QALY；PA 带来的背景成本节约变化不会对 ICER 产生定性影响。向任何患有膝 OA 的成年人提供 PA 计划（不仅限于不活跃者）可获得 31000 美元/QALY。
膝 OA 人群中具有 3 年疗效的 PA 计划具有有利的长期临床和经济效益。这些结果为政策制定者和支付者提供了依据，使他们考虑将 PA 干预措施纳入膝 OA 护理。
