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dc.contributor.authorFusco, Francescoen
dc.contributor.authorTurchetti, Giuseppeen
dc.date.accessioned2020-01-23T00:30:28Z
dc.date.available2020-01-23T00:30:28Z
dc.date.issued2016-05-17en
dc.identifier.issn2044-6055
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/301171
dc.description.abstractOBJECTIVES: To assess cost-effectiveness and cost utility of telerehabilitation (TR) versus standard rehabilitation (SR) after total knee replacement (TKR). DESIGN: Markov decision modelling of cost-effectiveness and cost-utility analysis based on patient-level and secondary data sources employing Italian National Health Service (NHS; Ita-NHS) and Society perspectives. SETTING: Primary care units (PCUs) in Italy. PARTICIPANTS: Patients discharged after TKR. INTERVENTIONS: Mixed SR-TR service (10 face-to-face sessions and 10 telesessions) versus SR (20 face-to-face sessions) PRIMARY AND SECONDARY OUTCOME MEASURES: The incremental cost per additional knee flexion range of motion (ROM) and per QALY gained by SR-TR compared with SR. Second, we considered the probability of being cost-effective and the probability of being more effective and less expensive. RESULTS: TR appears to be the cost-effective in the base case and in all of the considered scenarios, but is no longer more effective and less expensive if transportation costs are excluded. Comparing SR-TR with SR, the incremental cost-effectiveness ratio (ICER) adopting the Ita-NHS perspective for the base case was -€117/ROM gained. The cost-effectiveness probability for SR-TR was 0.98 (ceiling ratio: €50/ROM), while the joint probability of being more effective and less expensive was 0.87. Assuming that TR would increase health-related quality of life (HRQOL) utilities by 2.5%, the ICER adopting Ita-NHS perspective is -€960/QALY (cost-effectiveness probability: 1; ceiling ratio: €30 000/QALY). All the performed sensitivity analyses did not change the conclusions, but if transportation costs were excluded, the probability for SR-TR of being more clinically effective and less expensive reduced to 0.56. CONCLUSIONS: The analysis suggested SR-TR to be cost-effective, even less expensive and more effective if the PCUs provide ambulance transportations. However, the uncertainty related to TR costs, HRQOL and long-term clinical outcomes raises important topics for future research, which should be addressed to confirm our estimates. TRIAL REGISTRATION NUMBER: ISRCTN45837371.
dc.languageengen
dc.rightsAttribution-NonCommercial 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.subjectHEALTH ECONOMICSen
dc.subjectREHABILITATION MEDICINEen
dc.subjectArthroplasty, Replacement, Kneeen
dc.subjectCost-Benefit Analysisen
dc.subjectFemaleen
dc.subjectHumansen
dc.subjectItalyen
dc.subjectMaleen
dc.subjectMarkov Chainsen
dc.subjectModels, Economicen
dc.subjectPhysical Therapy Modalitiesen
dc.subjectPractice Guidelines as Topicen
dc.subjectPrimary Health Careen
dc.subjectProgram Evaluationen
dc.subjectQuality of Lifeen
dc.subjectTelerehabilitationen
dc.subjectTreatment Outcomeen
dc.titleTelerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care.en
dc.typeArticle
prism.endingPagee009964
prism.issueIdentifier5en
prism.publicationDate2016en
prism.publicationNameBMJ Openen
prism.startingPagee009964
prism.volume6en
dc.identifier.doi10.17863/CAM.48249
dcterms.dateAccepted2016-01-29en
rioxxterms.versionofrecord10.1136/bmjopen-2015-009964en
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2016-05-17en
dc.contributor.orcidFusco, Francesco [0000-0001-5515-3977]
dc.identifier.eissn2044-6055
rioxxterms.typeJournal Article/Reviewen


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Attribution-NonCommercial 4.0 International
Except where otherwise noted, this item's licence is described as Attribution-NonCommercial 4.0 International