ECONOMIC EVALUATION OF HYDROTHERAPY FOR PATIENT WITH KNEE OSTEOARTHRITIS: A CASE STUDY OF SIRINDHORN NATIONAL MEDICAL REHABILITATION INSTITUTE

Abstract

Knee Osteoarthritis incidence was increased followed the aging population in Thailand which is more than 12 percent of total population. Physiotherapy is one of the treatment plans for OA knee rehabilitation, aims to reduce pain, joint stiffness, and improve functional ability to prevent the level of severity that may lead to the total knee arthroplasty. Hydrotherapy is one of physiotherapy methodology that has been studied for a while in advantage effect to OA knee patient. However, Thailand has a limit number of hydrotherapy facility, none of study about economic evaluation. Thus, this study aimed to perform cost-effectiveness analysis and calculate an incremental cost-effectiveness ratio of hydrotherapy for OA knee patient in context of Sirindhorn National Medical Rehabilitation Institute (SNMRI), Thailand. The retrospective observational study for fiscal year 2016 to clarify the cost-effectiveness of hydrotherapy in OA knee patients compared among different frequency of hydrotherapy program; 1 visit/week, 2 visit/week, and 3 visit/week. The outcome measurement tool is The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) which is the international measurement tool to investigate the patient’s prognosis. The decreasing of total score revealed the better progression of patient. The result found that the frequency 2 visit/week has the lowest cost effectiveness ratio (180.49 baht/1 WOMAC decreased), more cost-effectiveness than 1 visit/week (183.98 baht/1WOMAC decreased and 2 visit/week (208.94 baht/1WOMAC decreased). For the incremental cost effectiveness ratio found that the increasing from 1 visit/week to 2 visit/week spent 156.88 baht/additional WOMAC decreased, and the increasing from 2 visit/week to 3 visit per week spent 293.62 baht/additional WOMAC decreased. Conclusion: Based on the context of SNMRI, hydrotherapy in OA knee patient for 2 visit per week is the most cost effectiveness and the lowest incremental cost effectiveness ratio compared to 1visit and 3 visit per week. This study lead to the evidence based guideline for policy maker of SNMRI and clinical service administrators as well as the future coming of another specialized rehabilitation hospital in Thailand which has the similar context to SNMRI.