A systematic review of economic evaluations of conservative treatments for chronic lower extremity musculoskeletal complaints

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To appraise and synthesise studies evaluating the clinical and cost effectiveness of conservative interventions for chronic lower extremity musculoskeletal (MSK) conditions and describe their characteristics, including type of economic evaluation, primary outcomes and which conditions.

The search strategy related to economic evaluations of lower limb MSK conditions that utilised conservative therapies. Eight electronic databases were searched (CENTRAL, MEDLINE, PubMed, EMBASE, CINAHL, PEDro, NHSEED, and Proquest) and reference lists from included articles. Quality of articles was appraised using a modified version of the economic evaluations’ reporting checklist (economic) and The Cochrane Collaboration’s tool for assessing risk of bias (clinical).

Twenty six studies were eligible and included in the review. Economic evaluations of conservative interventions for osteoarthritis or pain affecting the knee/hip (N¿=¿25; 93%) were most common. The main approaches adopted were cost utility analysis (N¿=¿17; 68%) or cost effectiveness analysis (N¿=¿5; 19%). Two studies involved interventions including footwear/foot orthoses; for heel pain (N¿=¿1; 4%) and overuse injuries (N¿=¿1; 4%). 50% of economic evaluations adopted the EQ-5D-3L as the primary outcome measure for quality of life and QALY calculations.

Economic evaluations have been conducted largely for exercise based interventions for MSK conditions of the hip and knee. Few economic evaluations have been conducted for other clinically important lower limb MSK conditions. A matrix presentation of costs mapped with outcomes indicated increasing costs with either no difference or improvements in clinical effectiveness. The majority of economic evaluations were of good reporting quality, as were the accompanying clinical studies.
Original languageEnglish
JournalRheumatology Advances in Practice
Publication statusPublished - 10 Sep 2018


  • systematic review
  • economic evaluation
  • lower extremity musculoskeletal conditions
  • cost effectiveness
  • conservative interventions

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