Health related quality of life and cost estimation for patients with knee osteoarthritis treated by supervised physical exercise: a perspective cohort study

Purpose: Physical exercise is strongly recommended by international Osteoarthritis (OA) guidelines, as an alternative treatment to total knee replacement (TKR) for patients with knee OA. There is little evidence in China HRQol of patients will be improved by physical exercise and its cost-effectiveness is unclear. This study aimed to investigate changes in HRQol of patients within one year of orthopedists-supervised physical exercise and to perform a cost estimation from patient’s perspective. Methods: This is an ongoing one-year prospective cohort study of 289 patients who have not undergone TKR and are currently treated by orthopedists-supervised physical exercise. HRQol of patients was assessed by EQ-5D-5L and EQ-VAS and Chinese preference weight was applied. A questionnaire was designed to capture patients’ self-reported direct and indirect costs related to knee OA. All questionnaires were completed during scheduled exercise or clinic visits at baseline, three, six and twelve months, respectively. Results: Average age of patients was 65.4 (SD:8.2) and 81.4% were female. At baseline, mean EQ-5D and EQ-5D-VAS were 0.74 (SD: 0.20) and 71.8 (SD 20.3) respectively. Statistically significant improvements in HRQol were observed at all follow-up visits and the biggest improvement was observed at one year. (EQ-5D: 0.17, 95%CI: 0.10-0.23, p<0.001; VAS: 12.14, 95% CI: 2.91- 21.37, p=0.008). Mean cost incurred within the past one year at baseline was 1324 US dollar (SD: 1738, median 796). Mean cost incurred within the past one year since starting physical exercise was 1272 US dollar (SD: 1553, median 568). The difference of costs was not statistically significant (52 US dollar, CI: -10-114, p=0.121). Conclusions: We observed significant improvements over time in HRQol of the OA patients who received the supervised physical exercise programme. The costs related to knee OA reduced after having the exercise programme while the difference was not statistically significant.