Sustained acoustic medicine as a non-surgical and non-opioid knee osteoarthritis treatment option: a health economic cost-effectiveness analysis for symptom management

Abstract

Background: Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management.

Methods: A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost-effectiveness plot comparing SAM treatment vs. SOC was also generated using 1000 iterations of the model. Lastly, the incremental cost-effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC).

Results: Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8641 and 0.52 versus SOC at: $6281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-min session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2276. Incremental cost-effectiveness demonstrated that most of the time (84%) SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC.

Conclusion: In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤ $50,000, it appears that SAM is a cost-effective treatment for knee OA.

Keywords: Cost-effect analysis; Health care cost; Osteoarthritis; Physical therapy; Socio-economical impact; Sustained Acoustic Medicine.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

PRISMA flow diagram for identification, screening, eligibility, and included articles in health economic modeling data

Fig. 2

Decision tree model of cost, effect size, and probability for the 6-month management of knee osteoarthritis. Physical therapy combined with SAM provides superior non-invasive and drug-free treatment versus the SOC care pathway for patients

Fig. 3

Model variables with greatest effect on cost of care pathway and the ranging parameters

Fig. 4

Sensitivity analysis on SAM cost where treatment is less expensive option to SOC

Fig. 5

Sensitivity analysis relative to PT session costs, where SAM treatment costs less than SOC

Fig. 6

Sensitivity analysis relative to the number of PT sessions where SAM treatment costs less than SOC

Fig. 7

Markov modeling scatter plot of cost effectiveness for SAM treatment versus SOC