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Cost effectiveness of telehealth-delivered exercise and dietary weight loss programs for knee osteoarthritis within a 12-month randomised trial.

OBJECTIVE
Evaluate the cost-effectiveness of telehealth-delivered Exercise and Diet+Exercise programs within 12 months.


METHODS
An economic evaluation within a 12 month, three-arm, parallel randomised trial of two 6-month telehealth-delivered exercise programs, with and without a dietary component. 415 people with knee osteoarthritis aged 45-80 years and body mass index 28-40 kg/m2 were assigned to one of two telehealth-delivered exercise programs (one without (n=172) and one with (n=175) a dietary component (ketogenic very low calorie diet;) or an education control (n=67), for 6-months, with 6 months follow-up. The primary economic outcomes were quality-adjusted life years (QALYs) and health system costs. Measured costs were the direct intervention (consultations, equipment/resources and meal replacements) and health care use in 2020 Australian dollars ($AU1.5=$US1). Secondary analysis included weight loss and work productivity gains.


RESULTS
The clinical trial demonstrated greater improvements in pain and function compared to information only for individuals with knee osteoarthritis and overweight/obesity. We can be 88% confident that Diet+Exercise is cost effective ($45,500 per QALY), 53% confident that Exercise is cost-effective ($67,600 per QALY) compared to Control, and 86% confident that augmenting Exercise with the Diet program is cost effective ($21,100 per QALY).


CONCLUSIONS
Telehealth-delivered programs targeting exercise with dietary intervention for people with knee OA who have overweight/obesity are likely to be cost-effective, particularly if potential long-term gains from weight loss and work productivity are realised.