Cost‐Effectiveness of Diet and Exercise for Overweight and Obese Patients With Knee Osteoarthritis

Background:Knee osteoarthritis and obesity are both major health problems. It is now admitted that the prevalence of knee osteoarthritis gets higher with obesity and that weight loss helps knee function and allows patients to avoid surgery.Objectives:The aim of this study was to study the influence of obesity on knee osteoarthritis features.Methods:A cross-sectional study was conducted in the university hospital Taher Sfar of Tunisia over a period of 6 months. Patients who had knee osteoarthritis confirmed by radiographs were included. Sociodemographic, clinical, radiological and therapeutic data were collected from medical records and visits. Obesity was defined by a body mass index (BMI) ≥30. Functional impairment was assessed by the Womac index and Lequesne index.Results:The study included 186 patients. There were 31 males and 155 femmes. The mean age was 60±10 years. The percentage of obese patients was 53,8%. The mean age was similar in both groups obese and non obese. There were more women in the obese group compared to the non obese group (p=0.0001), more patients who had diabetes mellitus and dyslipidemia (p=0.002). Non-obese patients had a shorter duration of symptoms with no statistical significance (p=0.151). Obese patients had more involvement of both knees (p<0.0001). Obesity did not have an impact on pain severity. Severity of radiological images (p=0,0001) were more frequent in obese patients. Functional impairment was similar in both groups. However, the percentage of patients having a very important functional impairment with Lequesne index was higher in obese patients (p<0.029). Obese patients also needed more physical therapy sessions (p=0.035).Conclusion:Knee osteoarthritis in obese patients is characterized with the femlae gender predominance, bilateral knee involvement, and a more severe images on radiographs. Thus the need for better control of weight and the importance of physical activity.References:[1]Coggon D, Reading I, Croft P, et al. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord J Int Assoc Study Obes 2001; 25: 622–627.Disclosure of Interests:None declared

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Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity

International Journal of Obesity ◽

10.1038/ijo.2010.246 ◽

2011 ◽

Vol 35 (8) ◽

pp. 1071-1078 ◽

Cited By ~ 52

Author(s):

M Forster ◽

J L Veerman ◽

J J Barendregt ◽

T Vos

Keyword(s):

Cost Effectiveness ◽

Overweight And Obesity ◽

Exercise Interventions ◽

Diet And Exercise

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Predicting knee joint loads in adults with knee osteoarthritis: the intensive diet and exercise for arthritis trial (IDEA)

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2013.02.184 ◽

2013 ◽

Vol 21 ◽

pp. S85

Author(s):

P. DeVita ◽

D. Beavers ◽

R.F. Loeser ◽

D.J. Hunter ◽

C. Legault ◽

...

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

Diet And Exercise ◽

Joint Loads

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Obesity and Surgical Treatment – A Cost-Effectiveness Assessment for Sweden

Nordic Journal of Health Economics ◽

10.5617/njhe.207 ◽

2014 ◽

Vol 2 (1) ◽

Author(s):

Sixten Borg ◽

Ingmar Näslund ◽

Ulf Persson ◽

Knut Ödegaard

Keyword(s):

Gastric Bypass ◽

Cost Effectiveness ◽

Conventional Treatment ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Cost Effective ◽

Health Concern ◽

Life Years ◽

Diet And Exercise ◽

The Cost

Background:The rising trend in the prevalence of obesity has during the past decades become a major public health concern in many countries, as obesity may lead to comorbidities and death. A frequent used marker for obesity is the Body Mass Index (BMI). The cost of treatment for obesity related diseases has become a heavy burden on national health care budget in many countries. While diet and exercise are the cornerstones of weight management, pharmacotherapy is often needed to achieve and maintain desired weight loss. In some cases of extreme obesity, bariatric surgery may be recommended. It is expected to increase by 50% in Sweden.Objective: The overall objective was to develop a cost-effectiveness model using the best available evidence to assess the cost-effectiveness of gastric bypass (GBP) surgical treatments for obesity in adult patients, in comparison with conventional treatment (CT), in Sweden from a healthcare perspective. With the model we also seeked to identify the lower cut-off point using BMI criteria, for the surgical intervention to be cost-effective. Methods:A micro-simulation model with an underlying Markov methodology was developed, that simulates individual patients. It simulates the outcomes of the patients in terms of treatment costs, life years, and quality adjusted life years (QALY) over his/her remaining lifetime. The costs are presented in SEK in the year 2006 price level (1 SEK ≈ 0.11 EUR ≈ 0.14 USD).Results: We estimated that the incremental cost per QALY gained will not exceed SEK 33,000 per QALY in patients with BMI < 35. In patients with BMI > 35 kg/m2, gastric bypass surgery has lower costs compared to conventional treatment. Conclusion: Gastric bypass surgery is a cost-effective intervention compared to conventional treatment consisting of watchful waiting, diet and exercise.

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ED1: COST-EFFECTIVENESS OF INTENSIVE METFORMIN VERSUS CONVENTIONAL THERAPY FOR OBESE PATIENTS WITH TYPE 2 DIABETES

Value in Health ◽

10.1016/s1098-3015(10)75806-x ◽

1999 ◽

Vol 2 (5) ◽

pp. 369

Author(s):

AJ Palmer ◽

PP Sendi ◽

V Gozzoli ◽

A Brandt ◽

GA Spinas

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Conventional Therapy ◽

Obese Patients

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Diet and Exercise for Obese Patients With Heart Failure—Reply

JAMA ◽

10.1001/jama.2016.2924 ◽

2016 ◽

Vol 315 (23) ◽

pp. 2619 ◽

Cited By ~ 2

Author(s):

Dalane W. Kitzman ◽

Mark J. Haykowsky ◽

William Kraus

Keyword(s):

Heart Failure ◽

Obese Patients ◽

Diet And Exercise ◽

Patients With Heart Failure

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The Cost-Effectiveness of Surgical Treatment of Medial Unicompartmental Knee Osteoarthritis in Younger Patients

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.n.00925 ◽

2015 ◽

Vol 97 (10) ◽

pp. 807-817 ◽

Cited By ~ 25

Author(s):

Joseph F. Konopka ◽

Andreas H. Gomoll ◽

Thomas S. Thornhill ◽

Jeffrey N. Katz ◽

Elena Losina

Keyword(s):

Cost Effectiveness ◽

Surgical Treatment ◽

Knee Osteoarthritis ◽

Younger Patients ◽

Unicompartmental Knee ◽

The Cost

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Effect of intensive diet and exercise on self-efficacy in overweight and obese adults with knee osteoarthritis: The IDEA randomized clinical trial

Translational Behavioral Medicine ◽

10.1093/tbm/iby037 ◽

2018 ◽

Vol 9 (2) ◽

pp. 227-235 ◽

Cited By ~ 4

Author(s):

Shannon L Mihalko ◽

Phillip Cox ◽

Daniel P Beavers ◽

Gary D Miller ◽

Barbara J Nicklas ◽

...

Keyword(s):

Clinical Trial ◽

Knee Osteoarthritis ◽

Randomized Clinical Trial ◽

Self Efficacy ◽

Obese Adults ◽

Diet And Exercise

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Cost-Effectiveness of Bariatric Surgery versus Medication Therapy for Obese Patients with Type 2 Diabetes in China: A Markov Analysis

Journal of Diabetes Research ◽

10.1155/2019/1341963 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Bin Wan ◽

Nan Fang ◽

Wei Guan ◽

Haixia Ding ◽

Ying Wang ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Health Care ◽

Health Insurance ◽

Cost Effectiveness ◽

Time Horizon ◽

Obese Patients ◽

Medication Therapy ◽

Insurance Payer

Aims/Introduction. The present study estimated the cost-effectiveness of bariatric surgery versus medication therapy for the management of recently diagnosed type 2 diabetes mellitus (T2DM) in obese patients from a Chinese health insurance payer perspective. Materials and Methods. A Markov model was established to compare the 40-year time costs and quality-adjusted life-years (QALYs) between bariatric surgery and medication therapy. The health-care costs in the bariatric surgery group, proportion of patients in each group with remission of diabetes, and state transition probabilities were calculated based on observed resource utilization from the hospital information system (HIS). The corresponding costs in the medication therapy group were derived from the medical insurance database. QALYs were estimated from previous literature. Costs and outcomes were discounted 5% annually. Results. In the base case analysis, bariatric surgery was more effective and less costly than medication therapy. Over a 40-year time horizon, the mean discounted costs were 86,366.55 RMB per surgical therapy patient and 113,235.94 CNY per medication therapy patient. The surgical and medication therapy patients lived 13.46 and 10.95 discounted QALYs, respectively. Bariatric surgery was associated with a mean health-care savings of 26,869.39 CNY and 2.51 additional QALYs per patient compared to medication therapy. Uncertainty around the parameter values was tested comprehensively in sensitivity analyses, and the results were robust. Conclusions. Bariatric surgery is a dominant intervention over a 40-year time horizon, which leads to significant cost savings to the health insurance payer and increases in health benefits for the management of recently diagnosed T2DM in obese patients in China.

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