Exercise-based models of care likely to produce significant quality-of-life impacts

Report by NZIER

Evidence for non-surgical, nonpharmacologic models of care in hip and knee Osteoarthritis (OA).

There are more than 408,000 New Zealanders who have osteoarthritis (OA). This form of arthritis is the most prevalent among people with arthritis, costing the health system a staggering $990 million annually. Direct productivity costs are $1.2 billion per year, and informal caregiver productivity costs $1.5 billion per year. These economic costs and the evidence for non-surgical, non-pharmacologic models of care in hip and knee OA spurred Arthritis NZ to commission the New Zealand Institute of Economic Research (NZIER) to identify the most robust recent economic evidence on nonsurgical, guidelineinformed models of care for OA of the hip and/or knee involving education and self-management, education and exercise, and exercise with or without manual therapy

The evidence presents some clear signals about costeffective models of care. The assessment indicates that achieving a favourable return on investment (ROI) from non-surgical, non-pharmacologic models of care is possible.

The MOA: Management of Osteoarthritis programme exercise model trialled in New Zealand proves this as it demonstrated health system savings and significant quality of life impacts.

Successful models of care for OA reduce GP visits, specialist visits and medication costs and help address unmet needs and avoid or delay surgery, reducing pressure on the system. The New Zealand Joint Clinic programme demonstrated these impacts. Participation in the Mobility Action Programme

(MAP) had high representation from Māori and Pacific People. It significantly improved confidence to self-manage their conditions and substantially reduced visits to GPs, specialists, and other secondary health services. The MAP was projected to be cost-effective over a 5-year time horizon. Exercise-based models of care appear to be the most likely to generate health system savings. Nonsurgical, non-pharmacologic models of care for OA often offer functional improvements over conventional care, resulting in productivity and quality of life gains that mean the societal ROI is even greater than the health system’s ROI. The highest ROI of all models reviewed was for the MOA exercise model of care, associated with a societal return on investment of $13.52 per dollar invested.

Key highlights:

These models of care can support the health system in achieving its goals. The health system reforms envisage a scenario where “everyone can access a wider range of support to stay well in the community, with more services designed around people’s needs and which better support self-care”, as well as more equitable access and outcomes. The findings by NZIER indicate that alternative models of care for OA can offer improved health outcomes at no additional cost to the health budget as well as being equity-enhancing due to the high costs of OA that patients currently bear through privately funded care and productivity losses, both of which people on low incomes cannot afford.

NZIER recommends improved access to exercisebased interventions (with additional core treatments such as weight management as appropriate) in the community for people with OA, and the use of a triage provider model to improve access to OA care, reduce pressure on the health system, and support a more patient-centred approach to OA.