Budget impact of the Walk With Ease program for knee osteoarthritis

Mahima T Kumara; Rebecca J Cleveland; Aleksandra M Kostic; Serena E Weisner; Kelli D Allen; Yvonne M Golightly; Heather Welch; Melissa Dale; Stephen P Messier; David J Hunter; Jeffrey N Katz; Leigh F Callahan; Elena Losina

doi:10.1016/j.ocarto.2024.100463

Budget impact of the Walk With Ease program for knee osteoarthritis

Osteoarthr Cartil Open. 2024 Mar 19;6(2):100463. doi: 10.1016/j.ocarto.2024.100463. eCollection 2024 Jun.

Authors

Mahima T Kumara^{1

2}, Rebecca J Cleveland³, Aleksandra M Kostic^{1

2}, Serena E Weisner⁴, Kelli D Allen⁵, Yvonne M Golightly^{6

7}, Heather Welch⁸, Melissa Dale⁸, Stephen P Messier⁹, David J Hunter¹⁰, Jeffrey N Katz^{1

2

11

12}, Leigh F Callahan¹³, Elena Losina^{1

2

11

14

15}

Affiliations

¹ Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
² Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
³ Thurston Arthritis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Thurston Arthritis Research Center, Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA.
⁵ Durham VA Health Care System, Durham, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
⁷ Thurston Arthritis Research Center and Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, NC, USA.
⁸ Montana Department of Public Health and Human Services, Helena, MT, USA.
⁹ Department of Health and Exercise Science, Wake Forest University, Salem, NC, USA.
¹⁰ Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
¹¹ Harvard Medical School, Boston, MA, USA.
¹² Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
¹³ Thurston Arthritis Research Center, Departments of Medicine and Orthopaedics, Osteoarthritis Action Alliance, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
¹⁴ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁵ Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.

Abstract

Objective: Walk With Ease (WWE) is an effective low-cost walking program. We estimated the budget impact of implementing WWE in persons with knee osteoarthritis (OA) as a measure of affordability that can inform payers' funding decisions.

Methods: We estimated changes in two-year healthcare costs with and without WWE. We used the Osteoarthritis Policy (OAPol) Model to estimate per-person medical expenditures. We estimated total and per-member-per-month (PMPM) costs of funding WWE for a hypothetical insurance plan with 75,000 members under two conditions: 1) all individuals aged 45+ with knee OA eligible for WWE, and 2) inactive and insufficiently active individuals aged 45+ with knee OA eligible. In sensitivity analyses, we varied WWE cost and efficacy and considered productivity costs.

Results: With eligibility unrestricted by activity level, implementing WWE results in an additional $1,002,408 to the insurance plan over two years ($0.56 PMPM). With eligibility restricted to inactive and insufficiently active individuals, funding WWE results in an additional $571,931 over two years ($0.32 PMPM). In sensitivity analyses, when per-person costs of $10 to $1000 were added with 10-50% decreases in failure rate (enhanced sustainability of WWE benefits), two-year budget impact varied from $242,684 to $6,985,674 with unrestricted eligibility and from -$43,194 (cost-saving) to $4,484,122 with restricted eligibility.

Conclusion: Along with the cost-effectiveness of WWE at widely accepted willingness-to-pay thresholds, these results can inform payers in deciding to fund WWE. In the absence of accepted thresholds to define affordability, these results can assist in comparing the affordability of WWE with other behavioral interventions.

Keywords: Budget impact analysis; Exercise; Knee osteoarthritis; Physical activity.