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Randomized Controlled Trial
. 2024 Jan;32(1):108-119.
doi: 10.1016/j.joca.2023.10.003. Epub 2023 Oct 13.

Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: A cluster-randomized controlled trial

Nina Østerås  1 , Eline Aas  2 , Tuva Moseng  3 , Leti van Bodegom-Vos  4 , Krysia Dziedzic  5 , Bård Natvig  6 , Jan Harald Røtterud  7 , Thea Vliet Vlieland  8 , Ove Furnes  9 , Anne Marie Fenstad  10 , Kåre Birger Hagen  11
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Free article
Randomized Controlled Trial

Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: A cluster-randomized controlled trial

Nina Østerås et al. Osteoarthritis Cartilage. 2024 Jan.
Free article

Abstract

Objective: To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis (OA) in primary healthcare as compared to usual care.

Design: In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design, we recruited 40 general practitioners (GPs), 37 physiotherapists (PTs), and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included the delivery of a 3-hour patient education and 8-12 weeks individually tailored exercise programs, and interactive workshops for GPs and PTs. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0-100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB).

Results: Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% confidence interval [CI] 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in quality-adjusted life-years gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months.

Conclusions: This study showed that implementing the model of care for OA in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care.

Trial registration number: ClinicalTrials.gov NCT02333656.

Keywords: Cost analysis; Osteoarthritis; Quality of health care; Randomized controlled trial.

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Conflict of interest statement

Declaration of Competing Interest NØ is part funded by The Research Council of Norway (No. 328657 REMEDY). EAA is part funded by The Research Council of Norway (No. 296114 NORCHER). KD is part funded by the National Institute for Health and Care Research (NIHR) Applied Health Research Collaboration (ARC) West Midlands (NIHR 200165). KD is an NIHR Senior Investigator (ID NIHR 200259). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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