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A Comprehensive Analysis of Economic Models Assessing the Cost Effectiveness of Physiotherapy Interventions Post Total Knee and Hip Replacement

Ekta Shah

Background: Osteoarthritis is a primary cause of pain and disability, and it places a considerable economic burden on individuals and the society. In the management of total knee or hip replacement (TKHR), the long-term effectiveness of physiotherapy interventions may slowly accumulate over a period.

Objectives: To evaluate all the model-based cost-effectiveness (CE) of physiotherapy interventions for patients with (TKHR).

Study selection: Studies that assessed model-based CE of physiotherapy interventions following TKHR and were published in English language. The methodological quality of the included studies was assessed using the Philips Checklist criteria.

Data extraction/data synthesis: Two reviewers, using a predefined data extraction form, independently extracted data. A descriptive synthesis was used to present the results.

Results: Eight hundred eighty-six studies were identified, and the only 3 that met the inclusion criteria were included. Different model structures and assumptions were used in the included studies. The included studies were conducted in the United States of America (n = 1), Singapore (n = 1) and Italy (n = 1). The societal (n = 2) and healthcare (n = 1) perspective were adopted in the studies. The included studies reported an incremental cost effectiveness ratio (ICER) of $57,200 and 27,471 Singapore dollar (SGD) per quality-adjusted life years in a time horizon of lifetime and three months, respectively. Physiotherapy (hydrotherapy) interventions were potentially cost-effective.

Conclusion: Based on the best available evidence, the findings of this review suggest that physiotherapy interventions were CE and cost saving. However, it is important to note that among others the CE of the interventions was a function of the healthcare system, duration of interventions, patient compliance and price.