{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T02:51:10Z","timestamp":1785552670875,"version":"3.56.0"},"reference-count":54,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Structured education and exercise therapy programs have been proposed to reduce reliance on total knee replacement (TKR) surgery and improve health care sustainability. The long-term cost-effectiveness of these programs is unclear.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To estimate the lifetime cost-effectiveness of implementing a national structured education and exercise therapy program for individuals with knee osteoarthritis with the option for future TKR compared with usual care (TKR for all).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This economic evaluation used a life table model in combination with a Markov model to compare costs and health outcomes of a national education and exercise therapy program vs usual care in the Australian health care system. Subgroup, deterministic, and probabilistic sensitivity analyses were completed. A hypothetical cohort of adults aged 45 to 84 years who would undergo TKR was created.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Structured education and exercise therapy intervention provided by physiotherapists. The comparator was usual care where all people undergo TKR without accessing the program in the first year.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Incremental net monetary benefit (INMB), with an incremental cost-effectiveness ratio threshold of 28\u202f033 Australian dollars (A$) per quality-adjusted life-year (QALY) gained, was calculated from a health care perspective. Transition probabilities, costs, and utilities were estimated from national registries and a randomized clinical trial.<\/jats:p><\/jats:sec>Results<\/jats:title>The hypothetical cohort included 61\u202f394 individuals (53.9% female; 93.6% aged \u226555 years). Implementation of an education and exercise therapy program resulted in a lifetime cost savings of A$498\u202f307\u202f942 (US $339\u202f922\u202f227), or A$7970 (US $5537) per individual, and resulted in fewer QALYs (0.43 per individual) compared with usual care. At a population level, education and exercise therapy was not cost-effective at the lifetime horizon (INMB, \u2212A$4090 [\u2212US $2841]). Subgroup analysis revealed that the intervention was cost-effective only for the first 9 years and over a lifetime only in individuals with no or mild pain at baseline (INMB, A$11 [US $8]). Results were robust to uncertainty around model inputs.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this economic evaluation of structured education and exercise therapy compared with usual care, the intervention was not cost-effective over the lifetime for all patients but was for the first 9 years and for those with minimal pain. These findings point to opportunities to invest early cost savings in additional care or prevention, including targeted implementation to specific subgroups.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.36715","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T15:00:46Z","timestamp":1727794846000},"page":"e2436715","source":"Crossref","is-referenced-by-count":14,"title":["Lifetime Cost-Effectiveness of Structured Education and Exercise Therapy for Knee Osteoarthritis in Australia"],"prefix":"10.1001","volume":"7","author":[{"given":"Sean","family":"Docking","sequence":"first","affiliation":[{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zanfina","family":"Ademi","sequence":"additional","affiliation":[{"name":"Centre for Medicine Use and Safety, Monash University, Melbourne, 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