Economic evaluation of aquatic exercise for persons with osteoarthritis

OBJECTIVES. To estimate cost and outcomes of the Arthritis Foundation aquat ic exercise classes from the societal perspective. DESIGN. Randomized trial of 20-week aquatic classes. Cost per quality-adjus ted life year (QALY) gained was estimated using trial data. Sample size was based on 80% power to reject the null hypothesis that the cost/QALY gained would not exceed $50,000. SUBJECTS AND METHODS. Recruited 249 adults from Washington State aged 55 to 75 with a doctor-confirmed diagnosis of osteoarthritis to participate in a quatic classes. The Quality of Well-Being Scale (QWB) and Current Health De sirability Rating (CHDR) were used for economic evaluation, supplemented by the arthritis-specific Health Assessment Questionnaire (HAQ), Center for E pidemiologic Studies-Depression Scale (CES-D), and Perceived Quality of Lif e Scale (PQOL) collected at baseline and postclass. Outcome results applied to life expectancy tables were used to estimate QALYs. Use of health care facilities was assessed from diaries/questionnaires and Medicare reimbursem ent rates used to estimate costs. Nonparametric bootstrap sampling of costs /QALY ratios established the 95% CI around the estimates. RESULTS. Aquatic exercisers reported equal (QWB) or better (CHDR, HAQ, PQOL ) health-related quality of life compared with controls. Outcomes improved with regular class attendance. Costs/QALY gained discounted at 3% were $205 ,186 using the QWB and $32,643 using the CHRD. CONCLUSION. Aquatic exercise exceeded $50,000 per QALY gained using the com munity-weighted outcome but fell below this arbitrary budget constraint whe n using the participant-weighted measure. Confidence intervals around these ratios suggested wide variability of cost effectiveness of aquatic exercis e.