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

Abstract

Objectives: To 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.

Methods: We 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.

Results: We 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.

Conclusions: The 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.

Keywords: arthroscopic partial meniscectomy; economic evaluation; knee; physical therapy; randomised controlled trial.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: all authors had financial support from The Netherlands Organisation for Health Research and Development (in Dutch: ZonMw) for the submitted work; the Achmea Healthcare Foundation (in Dutch Stichting Achmea Gezonheidszorg fonds) and the foundation of medical research at the OLVG, Amsterdam, the Netherlands; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Flow of patients through the trial. *The number of patients screened for eligibility was not available. †Missing data refer to data that was missing at a specific time point, while patients remained available for the remaining follow-up moments. ‡Loss to follow-up refers to actual drop-out from the study, for example, patients who did not participate at any of the remaining time points (cumulative numbers are total number of drop-outs). §Cumulative number of delayed APM refers to total number of participants from the PT group that have received delayed APM from baseline until that follow-up. APM, arthroscopic partial meniscectomy; FU, follow-up.

Figure 2

Cost-effectiveness planes, including non-inferiority margins, for quality-adjusted life-years (A) and the IKDC (B). IKDC, International Knee Documentation Committee; QALY, quality-adjusted life years.