Walk with ease for knee osteoarthritis: A cost-effectiveness analysis

Zoe E Zimmerman; Rebecca J Cleveland; Aleksandra M Kostic; Valia P Leifer; Serena E Weisner; Kelli D Allen; Yvonne M Golightly; Heather Welch; Melissa Dale; Stephen P Messier; David J Hunter; Jeffrey N Katz; Leigh F Callahan; Elena Losina

doi:10.1016/j.ocarto.2023.100368

Walk with ease for knee osteoarthritis: A cost-effectiveness analysis

Osteoarthr Cartil Open. 2023 May 10;5(3):100368. doi: 10.1016/j.ocarto.2023.100368. eCollection 2023 Sep.

Authors

Zoe E Zimmerman^{1

2}, Rebecca J Cleveland³, Aleksandra M Kostic^{1

2}, Valia P Leifer^{1

2}, Serena E Weisner⁴, Kelli D Allen^{5

6}, Yvonne M Golightly^{7

8}, Heather Welch⁹, Melissa Dale⁹, Stephen P Messier¹⁰, David J Hunter¹¹, Jeffrey N Katz^{1

2

12

13}, Leigh F Callahan¹⁴, Elena Losina^{1

2

12

15

16}

Affiliations

¹ Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
² Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
³ Thurston Arthritis Research Center; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Thurston Arthritis Research Center; Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA.
⁵ Durham VA Health Care System, Durham, USA.
⁶ University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
⁸ Thurston Arthritis Research Center and Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA.
⁹ Montana Department of Public Health and Human Services, Helena, MT, USA.
¹⁰ J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
¹¹ Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
¹² Harvard Medical School, Boston, MA, USA.
¹³ Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
¹⁴ Thurston Arthritis Research Center Departments of Medicine and Orthopaedics, Osteoarthritis Action Alliance, Dept. of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
¹⁵ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁶ Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.

Abstract

Objective: The Walk With Ease (WWE) program was developed by the Arthritis Foundation to help people with arthritis learn to exercise safely and improve arthritis symptoms. We sought to establish the value of the WWE program.

Methods: We used the Osteoarthritis Policy (OAPol) Model, a widely published and validated computer simulation of knee osteoarthritis (OA), to assess the cost-effectiveness of WWE in knee OA. We derived model inputs using data from a workplace wellness initiative in Montana that offered WWE to state employees. Our primary outcomes were quality-adjusted life years (QALYs) and costs over a 2-year period, which we used to calculate the incremental cost-effectiveness ratio (ICER). The base case analysis was restricted to subjects who were inactive or insufficiently active (<180 min/week of PA) at baseline. We performed scenario and probabilistic sensitivity analyses to determine the impact of uncertainty in model parameters on our results.

Results: In the base case analysis, adding WWE to usual care resulted in an ICER of $47,900/QALY. When the program was offered without preselection by baseline activity level, the ICER for WWE + usual care was estimated at $83,400/QALY. Results of the probabilistic sensitivity analysis indicated that WWE offered to inactive or insufficiently active individuals has a 52% chance of having an ICER <$50,000/QALY.

Conclusion: The WWE program offers good value for inactive/insufficiently active individuals. Payers may consider including such a program to increase physical activity in individuals with knee OA.

Keywords: Cost-effectiveness; Exercise; Knee osteoarthritis; Physical activity.