Health economic evaluation of weight reduction interventions in individuals suffering from overweight or obesity and a musculoskeletal diagnosis-a systematic review

Alexander P Schurz; Matthias M Walter; Melanie Liechti; Ron Clijsen; Tom Deliens; Jan Taeymans; Nathanael Lutz

doi:10.1186/s12891-024-07861-9

Health economic evaluation of weight reduction interventions in individuals suffering from overweight or obesity and a musculoskeletal diagnosis-a systematic review

BMC Musculoskelet Disord. 2024 Sep 16;25(1):744. doi: 10.1186/s12891-024-07861-9.

Authors

Alexander P Schurz^{1

2

3}, Matthias M Walter^{4

5}, Melanie Liechti^{4

6}, Ron Clijsen^{4

6

7

8}, Tom Deliens^{4

9}, Jan Taeymans^{4

6}, Nathanael Lutz^{4

6}

Affiliations

¹ Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium. alexander.philipp.schurz@vub.be.
² Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland. alexander.philipp.schurz@vub.be.
³ Faculty of Medicine, University of Bern, Murtenstrasse 10, Bern, CH-3008, Switzerland. alexander.philipp.schurz@vub.be.
⁴ Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
⁵ Science and Research, Physio Insight, Haslach Im Kinzigtal, Baden-Württemberg, Germany.
⁶ Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
⁷ Rehabilitation and Exercise Science Laboratory RESLab, Department of Business Economics, Health, and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.
⁸ International University of Applied Sciences THIM, Landquart, Switzerland.
⁹ Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.

Abstract

Background: Most of the worldwide population is overweight and suffers from the resulting musculoskeletal comorbidities such as knee osteoarthritis or back pain. Practice guidelines recommend weight loss interventions for individuals suffering from these conditions. This systematic review investigated whether including a weight loss intervention in the musculoskeletal therapy of these individuals was cost-effective compared to administering the musculoskeletal therapy alone.

Methods: This study followed the PRISMA guidelines to systematically and independently search six databases and select full health economic evaluations published up to May 2024 from health care or societal perspectives according to predefined eligibility criteria. Cost data were standardised to 2023 Belgium Euros. The methodological quality was assessed using two health economic-specific checklists.

Results: The searches produced 5'305 references, of which 8 studies were selected for a total of 1'726 participants. The interventions consisted of different exercise plans and nutritional targets. Six values were in the north-eastern; leading to increased quality-adjusted life year (QALY) and higher costs; and two in the south-eastern quadrant of the cost-utility plane; leading to increased QALYs and lower costs. Two studies observed no differences in QALYs. Incremental cost utility ratios (ICUR) ranged from €13'580.10 to €34'412.40 per additional QALY from a healthcare perspective. From a societal perspective, the ICUR was €30'274.84. The included studies fulfilled 86 percent of the criteria in trial-based economic evaluations and 57 percent in model-based economic evaluations. The most common limitations of the studies were related to appropriate cost measures' specifications, research questions, time horizon choices, and sensitivity analyses.

Conclusions: This systematic review showed weak but consistent evidence of cost-effectiveness for adding a weight loss intervention to musculoskeletal therapy for individuals with overweight, from either perspective. Further economic evaluations should evaluate the long-term cost-effectiveness of the intervention.

Trial registration: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY (2022,110,122).

Keywords: Cost-effectiveness analysis; Health economic evaluation; Musculoskeletal diseases; Overweight; Weight loss; Weight reduction programs.

Publication types

Systematic Review

MeSH terms

Cost-Benefit Analysis*
Exercise Therapy / economics
Exercise Therapy / methods
Health Care Costs / statistics & numerical data
Humans
Musculoskeletal Diseases / diagnosis
Musculoskeletal Diseases / economics
Musculoskeletal Diseases / therapy
Obesity* / diagnosis
Obesity* / economics
Obesity* / therapy
Overweight* / economics
Overweight* / therapy
Quality-Adjusted Life Years*
Weight Loss
Weight Reduction Programs / economics
Weight Reduction Programs / methods