Article Text

The cost effectiveness of behavioural graded activity in patients with osteoarthritis of hip and/or knee
  1. Veerle M H Coupé1,
  2. Cindy Veenhof2,
  3. Maurits W van Tulder3,
  4. Joost Dekker4,
  5. Johannes W J Bijlsma5,
  6. Cornelia H M Van den Ende2
  1. 1Department of Clinical Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
  2. 2Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
  3. 3EMGO Institute, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
  5. 5Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to:
    Dr Veerle Coupé
    Department of Clinical Epidemiology and Biostatistics, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands;v.coupe{at}


Objective: To evaluate whether exercise treatment based on behavioural graded activity comprising booster sessions is a cost-effective treatment for patients with osteoarthritis of the hip and/or knee compared with usual care.

Methods: An economic evaluation from a societal perspective was carried out alongside a randomised trial involving 200 patients with osteoarthritis of the hip and/or knee. Outcome measures were pain, physical functioning, self-perceived change and quality of life, assessed at baseline, 13, 39 and 65 weeks. Costs were measured using cost diaries for the entire follow-up period of 65 weeks. Cost and effect differences were estimated using multilevel analysis. Uncertainty around the cost-effectiveness ratios was estimated by bootstrapping and graphically represented on cost-effectiveness planes.

Results: 97 patients received behavioural graded activity, and 103 patients received usual care. At 65 weeks, no differences were found between the two groups in improvement with respect to baseline on any of the outcome measures. The mean (95% confidence interval) difference in total costs between the groups was −€773 (−€2360 to €772)—that is, behavioural graded activity resulted in less cost but this difference was non-significant. As effect differences were small, a large incremental cost-effectiveness ratio of €51 385 per quality adjusted life year was found for graded activity versus usual care.

Conclusions: This study provides no evidence that behavioural graded activity is either more effective or less costly than usual care. Yielding similar results to usual care, behavioural graded activity seems an acceptable method for treating patients with osteoarthritis of the hip and/or knee.

  • OMERACT, Outcome Measures in Rheumatology
  • QALY, quality adjusted life year
  • WOMAC, Western Ontario and McMaster Universities

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  • Published Online First 31 July 2006

  • Funding: This study was supported by a grant from the Dutch Health Care Insurance Board.

  • Competing interests: None.

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