How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study

• Published in: British journal of sports medicine Vol. 54; no. 9; pp. 538 - 545
• Main Authors: van de Graaf, Victor A, van Dongen, Johanna M, Willigenburg, Nienke W, Noorduyn, Julia C A, Butter, Ise K, de Gast, Arthur, Saris, Daniel B F, van Tulder, Maurits W, Poolman, Rudolf W, Scholtes, VAB, Mutsaerts, ELAR, Wolkenfelt, J, Krijnen, M R, Deurzen van, DFP, Moojen, DJF, Bloembergen, CH, Snijders, T, Halma, JJ, Neeter, C, Kerkhoffs, GMMJ, Peters, R W, van den Brand, ICJB, deVos-Jakobs, S, Spoor, AB, Gosens, T, Rezaie, W, Hofstee, DJ, Burger, BJ, Haverkamp, D, Vervest, AMJS, van Rheenen, TA, Wijsbek, AE, van Arkel, ERA, Thomassen, BJW, Sprague, S, Mol, BWJ, Wolterbeek, N
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine 01.05.2020; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Absenteeism; Adult; Aged; Arthritis; arthroscopic partial meniscectomy; Arthroscopy - economics; Cost analysis; Cost-Benefit Analysis; economic evaluation; Equivalence Trials as Topic; Female; Follow-Up Studies; Gender; Health Care Costs; Hospitals; Humans; Knee; Male; Meniscectomy - economics; Middle Aged; Original Research; Physical therapy; Physical Therapy Modalities - economics; Productivity; Questionnaires; randomised controlled trial; Shadow prices; Surgery; Tibial Meniscus Injuries - surgery; Tibial Meniscus Injuries - therapy; Netherlands; arthroscopic partial meniscectomy; knee; randomised controlled trial; physical therapy; economic evaluation
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2018-100065

ObjectivesTo examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a societal perspective. In a secondary analysis—this paper—we examined whether PT is non-inferior to APM.MethodsWe recruited patients aged 45–70 years with a non-obstructive meniscal tear in nine Dutch hospitals. Resource use was measured using web-based questionnaires. Measures of effectiveness included knee function using the International Knee Documentation Committee (IKDC) and quality-adjusted life-years (QALYs). Follow-up was 24 months. Uncertainty was assessed using bootstrapping techniques. The non-inferiority margins for societal costs, the IKDC and QALYs, were €670, 8 points and 0.057 points, respectively.ResultsWe randomly assigned 321 patients to PT (n=162) or APM (n=159). PT was associated with significantly lower costs after 24 months compared with APM (−€1803; 95% CI −€3008 to −€838). The probability of PT being cost-effective compared with APM was 1.00 at a willingness to pay of €0/unit of effect for the IKDC (knee function) and QALYs (quality of life) and decreased with increasing values of willingness to pay. The probability that PT is non-inferior to APM was 0.97 for all non-inferiority margins for the IKDC and 0.89 for QALYs.ConclusionsThe probability of PT being cost-effective compared with APM was relatively high at reasonable values of willingness to pay for the IKDC and QALYs. Also, PT had a relatively high probability of being non-inferior to APM for both outcomes. This warrants further deimplementation of APM in patients with non-obstructive meniscal tears.Trial registration numbers NCT01850719 and NTR3908.