Real‐World Cost‐Effectiveness of a Standardized Education and Exercise Therapy Program for Hip and Knee Osteoarthritis Compared to Usual Care
Bibliographic record
Abstract
OBJECTIVE: We estimated the real-world cost-effectiveness of a standardized education and exercise therapy program (GLA:D) compared to usual care (UC) for people managing hip and/or knee osteoarthritis (HKOA). METHODS: We used a prospective matched cohort design to recruit people (aged >45 years) diagnosed with HKOA who used GLA:D or UC (not on a surgical waitlist) throughout Alberta, Canada. Demographics, pain, function, quality of life, and an HKOA-related cost questionnaire were administered over 12 months. The primary Ministry of Health (MOH) perspective used administrative data to estimate all public health care costs. The secondary health care perspective included MOH, private insurance, and out-of-pocket costs. We calculated our cost-effectiveness measure, incremental net monetary benefit (INMB) in Canadian dollars, over 12 months with a $30,000/quality-adjusted life years (QALY) willingness to pay threshold and adjusted for the differences between cohorts. A Markov model was used to extend INMB over a lifetime time horizon (3% discounting). Model uncertainty was explored by probabilistic sensitivity analyses. RESULTS: A total of 254 participants (GLA:D n = 127, UC n = 127; 72% female), with a mean age of 64.3 years (95% confidence interval [CI]: 63.1-65.5), diagnosed with knee osteoarthritis (63%), hip osteoarthritis (24%), or both (13%) were observed for a mean of 5.5 years (95% CI: 4.8-6.3). The adjusted INMB of GLA:D compared to UC was $6,065 (95% CI: $3,648-$8,482) and $499 (95% CI: -$2,913 to $3,912) from an MOH and health care perspective over 12 months and $6,574 and $1,775 over a lifetime with 54% and 51% probability of being cost-effective using a threshold of willingness to pay of $30,000 per QALY. CONCLUSIONS: GLA:D had a positive INMB compared to UC from the MOH perspective over 12 months. The INMB remained positive but was less certain over a lifetime or when out-of-pocket and private insurance costs were considered.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".