Cost‐Effectiveness of Telehealth‐Delivered Exercise and Dietary Weight Loss Programs for Knee Osteoarthritis Within a Twelve‐Month Randomized Trial

Objective To evaluate the cost‐effectiveness of telehealth‐delivered exercise and diet‐plus‐exercise programs within 12 months. Methods An economic evaluation within a 12‐month, 3‐arm, parallel randomized trial of two 6‐month telehealth‐delivered exercise programs, with and without a dietary component. A total of 415 people with knee osteoarthritis ages 45–80 years and body mass index of 28–40 kg/m2 were assigned to 1 of 2 telehealth‐delivered exercise programs, 1 without (n = 172) and 1 with (n = 175) a dietary component (ketogenic very low calorie diet), or to an education control (n = 67), for 6 months, with 6 months follow‐up. The primary economic outcomes were quality‐adjusted life years (QALYs) and health system costs. Measured costs were the direct intervention (consultations, equipment/resources, and meal replacements) and health care use in 2020 Australian dollars ($AU1.5 = $US1). Secondary analysis included weight loss and work productivity gains. Results The clinical trial demonstrated greater improvements in pain and function compared to information only for individuals with knee osteoarthritis and overweight/obesity. We can be 88% confident that diet plus exercise is cost effective ($45,500 per QALY), 53% confident that exercise is cost‐effective ($67,600 per QALY) compared to the control, and 86% confident that augmenting exercise with the diet program is cost effective ($21,100 per QALY). Conclusion Telehealth‐delivered programs targeting exercise with dietary intervention for people with knee osteoarthritis who have overweight/obesity are likely to be cost‐effective, particularly if potential long‐term gains from weight loss and work productivity are realized.