UK researchers examining economic data on 12 non-pharmacological interventions for osteoarthritis of the knee (KOA) have found acupuncture and transcutaneous electrical nerve stimulation (TENS) to be cost-effective. The authors applied network meta-analysis to data from 88 randomised controlled trials including 7,507 patients. They based their cost-effectiveness estimations on a threshold of £20–30,000 per QALY (quality-adjusted life year – a measure of disease burden used to assess the value for money of medical interventions), as this is used by the UK’s National Institute for Health and Care Excellence (NICE) to assess whether treatments represent a cost-effective use of UK NHS resources. When all trials were considered, TENS was found to be cost-effective at the NICE threshold, with an incremental cost-effectiveness ratio of £2,690 per QALY versus usual care (meaning one quality-adjusted life year would be gained for each additional £2,690 spent on TENS). When only higher quality trials were considered, acupuncture was found to be cost-effective (with an incremental cost-effectiveness ratio of £13,502 per QALY versus TENS). The authors further noted that, while acupuncture is not currently recommended by NICE as a treatment for KOA, based on their calculations some interventions that are recommended by NICE (insoles, braces and manual therapy) are unlikely to be cost-effective and therefore should not be prioritised for commissioning within the NHS.
Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One. 2017 Mar 7;12(3):e0172749.

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