Physical Therapy is More Cost-Effective than Intraarticular Steroids in Knee OA Save

A randomized trial compared the incremental cost-effectiveness of physical therapy and intra-articular glucocorticoid (IA GC) injection as initial treatment for knee osteoarthritis showed that physical therapy gained more quality-adjusted life-years compared with those receiving glucocorticoid injection.

This economic evaluation was a secondary analysis of a randomized clinical trial performed from October 1, 2012, to May 4, 2017.   At issue was how the more expensive physical therapy would stack up against IA GC injection. The main outcome was incremental cost-effectiveness between 2 alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICERs) were used to identify the proportion of ICERs under the specific willingness-to-pay level ($50 000-$100 000). Health care system costs (total and knee related) and health-related quality-of-life based on quality-adjusted life-years (QALYs) were obtained.

A total of 156 participants were randomized to either PT or IA GC and followed up for 1 year.

The 1-year knee-related medical costs for IA GC was $2113 ($4224) compared to $2131 ($1015) in the physical therapy group. The mean difference in QALY significantly favored physical therapy at 1 year (0.076; 95% CI, 0.02-0.126; P = .003). Physical therapy was the more cost-effective intervention, with an ICER of $8103 for knee-related medical costs, with a 99.2% probability that results fall below the willingness-to-pay threshold of $100 000.

In this randomized clinical trial, physical therapy patients gained more quality-adjusted life-years compared with those receiving IA GC injection. Costs related to knee care were similar between groups, although total medical costs for any reason were higher in the physical therapy group.

While a course of physical therapy may more expensive than IA GC injections, the greater improvement in quality-adjusted life-years may be worth the additional cost of PT.