Cost-utility Analysis of Interventions to Improve Effectiveness of Exercise Therapy for Adults with Knee Osteoarthritis: the BEEP Trial

Jesse Kigozi, Sue Jowett, Elaine Nicholls, Stephanie Tooth, Elaine M. Hay, Nadine E. Foster

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Objectives. Evidence regarding the cost-effectiveness of enhancing physicaltherapy exercise programmes in order to improve outcomes for patients with knee OA remains unclear. This study investigates the cost-effectiveness of two enhanced physical therapy interventions compared with usual physical therapy care (UC) for adults with knee osteoarthritis (OA).

Methods. A trial-based cost-utility analysis of Individually Tailored Exercise (ITE) or Targeted Exercise Adherence (TEA) compared with UC was undertaken over aperiod of 18 months. Patient-level costs were obtained and effectiveness measured in terms of quality-adjusted life years (QALYs) allowing the calculation of cost per QALY gained from a base-case UK healthcare perspective.

Results. The UC group was associated with lower NHS costs (ITE - UC: £273.30(95% CI: £-62.10 to £562.60); TEA - UC: £141.80 (95% CI: £-135.60 to £408.10)), and slightly higher QALY gains (ITE – UC: -0.015 (95% CI:-0.057 to 0.026); TEA - UC: -0.003 (95% CI:-0.045 to 0.038). In the base case, UC was the most likely costeffective option (probability < 40% of ITE or TEA cost-effective at £20,000/QALY). Differences in total costs were due to intervention costs, number of visits to NHS consultants and knee surgery, which were higher in both the ITE and TEA groups. 

Conclusions: This is the first economic evaluation comparing usual physical therapy care versus enhanced exercise interventions for knee OA that involves greater exercise individualisation, supervision and progression or that focuses on exercise and physical activity adherence over the longer-term. Our findings show that UC is likely to be the most cost-effective option.Key words economic evaluation, cost-effectiveness, cost-utility, osteoarthritis, knee pain, exercise

Trial registration: Current Controlled Trials ISRCTN 93634563

Trial protocol Full details of the trial protocol can be found in the SupplementaryAppendix, available with the full text of this article at doi: 10.1186/1471-2474-15-254
Original languageEnglish
Article numberrky018
JournalRheumatology Advances in Practice
Issue number2
Early online date6 Jun 2018
Publication statusPublished - Jul 2018


  • economic evaluation
  • cost-effectiveness
  • cost-utility
  • osteoarthritis
  • knee pain
  • exercise


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