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    Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?
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The content on this page is not current guidance and is only for the purposes of the consultation process.

1 Recommendations

1.1 AposHealth is recommended as a cost saving option to manage knee osteoarthritis in people 16 years and over only if:

  • non-surgical standard care has not worked well enough and

  • their condition meets the referral criteria for total knee replacement surgery but they cannot have or do not want surgery.

1.2 Further data collection is recommended on quality of life, health resource use and long-term rates of knee replacement for people with knee osteoarthritis that meets the criteria for total knee replacement surgery, but who cannot have or do not want surgery and are using AposHealth in the NHS.

1.3 Further research or data collection is recommended on AposHealth for people with knee osteoarthritis that does not meet the referral criteria for total knee replacement surgery. Find out more in the further research section in this guidance.

Why the committee made these recommendations

Clinical evidence from a high quality randomised controlled trial shows that AposHealth improves scores for measuring pain, stiffness and function when compared with a sham device in people with symptomatic knee osteoarthritis. But it is uncertain whether the improvements are clinically meaningful in terms of reducing symptoms. Two comparative studies compared AposHealth with a sham device. There is a lack of evidence directly comparing AposHealth with standard care. However, this comparison is difficult because standard care is difficult to define for this condition. The evidence from studies that did not compare AposHealth with another treatment or sham device, suggests that it improves pain, stiffness and function compared with before using AposHealth. Clinical and patient expert adviser experience of using AposHealth agreed with this.

The clinical evidence also suggests that AposHealth may delay the need for knee surgery, but the length of this delay is uncertain. The delay seen in the evidence reflects the real-world experience of clinical and patient experts who are using the technology in the NHS.

The potential cost savings from AposHealth mainly come from reduced standard care costs and a reduction in knee replacement surgery. Cost analyses suggest AposHealth is cost saving by £1,958 per person when compared with standard care over 5 years. Because the evidence for the potential cost savings is limited, further data collection is recommended to understand if cost savings are made once AposHealth is used in the NHS.