The efficacy of self-management programs is typically shown in clinical trials. Whether the procedures are cost-effective, however, is another matter. Hurley and coworkers did a cost evaluation of a program, ESCAPE-knee pain. They estimated the costs of usual primary care and participation in ESCAPE-knee pain program delivered to individuals or groups of participants. Information on resource use and informal care received was collected during face-to-face interviews. Cost-effectiveness and cost-utility were assessed from between-group differences in costs, function (primary clinical outcome), and quality-adjusted life years. Rehabilitation, either individual or in groups, cost 224 pounds more per person than usual primary care. The probability of rehabilitation being more cost-effective than usual primary care was 90% if decision makers were willing to pay 1,900 pounds for improvements in functioning. Individual cost were more than double that of courses taught in groups. However, the probability of individual programs is more cost-effective than group programs as increased willingness to pay increased. The lack of differences in quality-adjusted life years across the arms led to lower probabilities of cost-effectiveness based on this outcome.

VALUE OF STUDY TO READER: The authors concluded that the ESCAPE-knee pain programs had small cost implications, but it was more likely to be cost-effective in improving function than usual primary care. Group rehabilitation reduced costs without reducing clinical effectiveness, thus increasing the probability of cost-effectiveness with the programs. As in similar instances, we’ve argued that the real cost-savings of self-management programs, such as that described, can only be seen if patients are followed over a period of time. This could have been demonstrated in the study had they conducted long-term follow-up with the patients.

MV Hurley et al. Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain. Arthritis and Rheumatology, 2007; 57:1220-1229.