{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:04:45Z","timestamp":1790103885091,"version":"4.0.1"},"reference-count":38,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,5]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We evaluated the cost-effectiveness of weight-loss interventions for adults with knee osteoarthritis (OA) and obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and narrative synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>MEDLINE, EMBASE via Ovid, Global Index Medicus and Web of Science and a clinical trial registry (ClinicalTrials.gov), published up to June 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>English-language studies evaluating the cost-effectiveness of intentional weight-loss interventions in adults (\u226518 years) with knee OA were included. Studies without cost-effectiveness outcomes, abstracts and conference proceedings were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Two reviewers independently extracted study characteristics and economic outcomes. A narrative synthesis was conducted and costs were standardised to 2024 British pounds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>1014 references were identified; eight studies met inclusion criteria, including six model-based economic evaluations and two randomised trials. Most studies used lifetime horizons and presented data from healthcare or societal perspectives. Combined diet and exercise programmes showed quality-adjusted life years (QALY) gains of 0.05\u20130.16 with incremental cost-effectiveness ratios (ICERs) of \u00a316 915 and \u00a331 305 per QALY, while bariatric surgery yielded larger gains (0.81\u20131.7 QALYs) at lower ICERs (\u00a34361 to \u00a319 303 per QALY). Pharmacological interventions were effective but costly with ICER (\u00a332 265 to \u00a335 832 per QALY). Evidence regarding telehealth-only interventions was mixed, with reported ICERs ranging from no significant effect to \u00a332 722 per QALY gained. The included studies fulfilled 79\u201386% of the criteria from Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and were all rated good on the Drummond checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using standard UK cost-effectiveness thresholds (\u00a325 000 to \u00a335 000 per QALY), bariatric surgery appears most likely to be cost-effective for patients with knee OA, although this conclusion is based primarily on US model-based evidence. Pharmacological therapies may be cost-effective, although their economic value is sensitive to drug pricing and willingness-to-pay thresholds. High-quality UK-based economic evaluations are needed to establish the cost-effectiveness of Glucagon-Like Peptide-1 (GLP-1) receptor agonists for knee OA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117500","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:35:38Z","timestamp":1790102138000},"page":"e117500","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Systematic review of cost-effectiveness analyses of weight loss interventions for knee osteoarthritis"],"prefix":"10.1136","volume":"16","author":[{"given":"Yue","family":"Gao","sequence":"first","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-1160","authenticated-orcid":false,"given":"Hema","family":"Mistry","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"},{"name":"University of Warwick, Warwick Medical School, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatema","family":"Dhaif","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"},{"name":"University of Warwick, Warwick Medical School, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blair","family":"Mcmurray","sequence":"additional","affiliation":[{"name":"George Eliot Hospital NHS Trust, Nuneaton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjana","family":"Susarla","sequence":"additional","affiliation":[{"name":"George Eliot Hospital NHS Trust, Nuneaton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5504-7189","authenticated-orcid":false,"given":"Seyran","family":"Naghdi","sequence":"additional","affiliation":[{"name":"University of Warwick, Warwick Medical School, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092211353250000_16.9.e117500.1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00163-7"},{"key":"2026092211353250000_16.9.e117500.2","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/S0140-6736(25)00355-1","article-title":"Global, regional, and national prevalence of adult overweight and obesity, 1990\u20132021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021","volume":"405","author":"Ng","year":"2025","journal-title":"The Lancet"},{"key":"2026092211353250000_16.9.e117500.3","unstructured":"Frontier Economics . The economic and productivity costs of obesity and overweight in the UK: London; Nesta, 2025. Available: https:\/\/media.nesta.org.uk\/documents\/The_economic_and_productivity_costs_of_obesity_and_overweight_in_the_UK_.pdf"},{"key":"2026092211353250000_16.9.e117500.4","unstructured":"O\u2019Malley JLB . Versus arthritis representation to the budget 2018: London; Versus Arthritis, 2018. Available: https:\/\/www.arthritis-uk.org\/media\/1996\/versus-arthritis-response-budget-2018pdf.pdf"},{"key":"2026092211353250000_16.9.e117500.5","unstructured":"Bell M , Deyes K . Estimating the full costs of obesity in the UK: London; Frontier Economics for Novo Nordisk, 2022. Available: https:\/\/www.frontier-economics.com\/media\/hgwd4e4a\/the-full-cost-of-obesity-in-the-uk.pdf"},{"key":"2026092211353250000_16.9.e117500.6","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-60587-1","article-title":"Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis","volume":"10","author":"Raud","year":"2020","journal-title":"Sci Rep"},{"key":"2026092211353250000_16.9.e117500.7","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/acr.25265","article-title":"Clinical, Health-Related Quality of Life, and Gait Differences Among Obesity Classes in Adults With Knee Osteoarthritis","volume":"76","author":"Messier","year":"2024","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026092211353250000_16.9.e117500.8","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.003419"},{"key":"2026092211353250000_16.9.e117500.9","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.065904"},{"key":"2026092211353250000_16.9.e117500.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-024-07861-9","article-title":"Health economic evaluation of weight reduction interventions in individuals suffering from overweight or obesity and a musculoskeletal diagnosis-a systematic review","volume":"25","author":"Schurz","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"2026092211353250000_16.9.e117500.11","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.joca.2020.10.002","article-title":"Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review","volume":"29","author":"Mazzei","year":"2021","journal-title":"Osteoarthr Cartil"},{"key":"2026092211353250000_16.9.e117500.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026092211353250000_16.9.e117500.13","doi-asserted-by":"crossref","first-page":"e588","DOI":"10.1093\/pubmed\/fdac036","article-title":"Strengthening systematic reviews in public health: guidance in the Cochrane Handbook for Systematic Reviews of Interventions, 2nd edition","volume":"44","author":"Cumpston","year":"2022","journal-title":"J Public Health (Oxf)"},{"key":"2026092211353250000_16.9.e117500.14","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"2026092211353250000_16.9.e117500.15","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1001\/jamasurg.2021.0540","article-title":"CHEERS Reporting Guidelines for Economic Evaluations","volume":"156","author":"Fayanju","year":"2021","journal-title":"JAMA Surg"},{"key":"2026092211353250000_16.9.e117500.16","doi-asserted-by":"publisher","DOI":"10.1332\/174426410X482999"},{"key":"2026092211353250000_16.9.e117500.17","doi-asserted-by":"crossref","unstructured":"NICE cost-effectiveness thresholds increased as UK strikes trade deal with United States. Pharm J 2025. doi:10.1211\/PJ.2025.1.388466","DOI":"10.1211\/PJ.2025.1.388466"},{"key":"2026092211353250000_16.9.e117500.18","unstructured":"Drummond MF , O\u2019Brien BJ , Torrance GW , et al . Methods for the economic evaluation of health care programmes 2nd. Oxford: Oxford University Press, 1997."},{"key":"2026092211353250000_16.9.e117500.19","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1002\/acr.25323","article-title":"Cost-Effectiveness of Community-Based Diet and Exercise for Patients with Knee Osteoarthritis and Obesity or Overweight","volume":"76","author":"Kopp","year":"2024","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026092211353250000_16.9.e117500.20","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1002\/acr.24967","article-title":"Cost-Effectiveness of Surgical Weight-Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity","volume":"75","author":"Kostic","year":"2023","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026092211353250000_16.9.e117500.21","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1002\/acr.23716","article-title":"Cost-Effectiveness of Diet and Exercise for Overweight and Obese Patients With Knee Osteoarthritis","volume":"71","author":"Losina","year":"2019","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026092211353250000_16.9.e117500.22","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1002\/acr.25044","article-title":"Cost-Effectiveness of Weight-Loss Interventions Prior to Total Knee Replacement for Patients With Class III Obesity","volume":"75","author":"Kostic","year":"2023","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026092211353250000_16.9.e117500.23","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.7326\/ANNALS-24-03609","article-title":"The Cost-Effectiveness of Semaglutide and Tirzepatide for Patients With Knee Osteoarthritis and Obesity","volume":"178","author":"Betensky","year":"2025","journal-title":"Ann Intern Med"},{"key":"2026092211353250000_16.9.e117500.24","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.N.00416","article-title":"Cost-Effectiveness of Bariatric Surgery Prior to Total Knee Arthroplasty in the Morbidly Obese: A Computer Model-Based Evaluation","volume":"98","author":"McLawhorn","year":"2016","journal-title":"J Bone Joint Surg Am"},{"key":"2026092211353250000_16.9.e117500.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-018-6300-1","article-title":"Economic evaluation of telephone-based weight loss support for patients with knee osteoarthritis: a randomised controlled trial","volume":"18","author":"O\u2019Brien","year":"2018","journal-title":"BMC Public Health"},{"key":"2026092211353250000_16.9.e117500.26","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1002\/acr.25022","article-title":"Cost-Effectiveness of Telehealth-Delivered Exercise and Dietary Weight Loss Programs for Knee Osteoarthritis Within a Twelve-Month Randomized Trial","volume":"75","author":"Harris","year":"2023","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026092211353250000_16.9.e117500.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-017-1441-4","article-title":"Weight-loss and exercise for communities with arthritis in North Carolina (we-can): design and rationale of a pragmatic, assessor-blinded, randomized controlled trial","volume":"18","author":"Messier","year":"2017","journal-title":"BMC Musculoskelet Disord"},{"key":"2026092211353250000_16.9.e117500.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2015.03.034"},{"key":"2026092211353250000_16.9.e117500.29","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1001\/jamasurg.2017.5025","article-title":"Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study","volume":"153","author":"Courcoulas","year":"2018","journal-title":"JAMA Surg"},{"key":"2026092211353250000_16.9.e117500.30","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2403664"},{"key":"2026092211353250000_16.9.e117500.31","doi-asserted-by":"publisher","DOI":"10.1007\/s13679-017-0262-y"},{"key":"2026092211353250000_16.9.e117500.32","unstructured":"National Institute for Health and Care Excellence . The guidelines manual: assessing cost effectiveness. In: Process and methods guide (PMG6). London: NICE, 2012. Available: https:\/\/www.nice.org.uk\/process\/pmg6\/chapter\/assessing-cost-effectiveness"},{"key":"2026092211353250000_16.9.e117500.33","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-021-00849-8"},{"key":"2026092211353250000_16.9.e117500.34","doi-asserted-by":"crossref","first-page":"2821","DOI":"10.1007\/s12325-025-03194-8","article-title":"Analysis of Tirzepatide Acquisition Costs and Weight Reduction Outcomes in the United Kingdom: Insights from the SURMOUNT-1 Study","volume":"42","author":"Evans","year":"2025","journal-title":"Adv Ther"},{"key":"2026092211353250000_16.9.e117500.35","unstructured":"NHS Business Services Authority . Mounjaro (tirzepatide) price increase \u2013 drug tariff redetermination. Newcastle upon Tyne: NHS Business Services Authority, 2025. Available: https:\/\/www.nhsbsa.nhs.uk\/mounjaro-tirzepatide-price-increase-drug-tariff-redetermination"},{"key":"2026092211353250000_16.9.e117500.36","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2024.102475","article-title":"Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial","volume":"69","author":"Jensen","year":"2024","journal-title":"EClinicalMedicine"},{"key":"2026092211353250000_16.9.e117500.37","doi-asserted-by":"crossref","DOI":"10.1016\/j.ocarto.2022.100298","article-title":"Recommendations for weight management in osteoarthritis: A systematic review of clinical practice guidelines","volume":"4","author":"Lim","year":"2022","journal-title":"Osteoarthr Cartil Open"},{"key":"2026092211353250000_16.9.e117500.38","article-title":"PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis","volume":"18","author":"Haddaway","year":"2022","journal-title":"Campbell Syst Rev"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-117500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:35:45Z","timestamp":1790102145000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-117500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,22]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bmjopen-2026-117500"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-117500","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}