1.1 AposHealth is recommended as a cost-saving option to manage knee osteoarthritis in adults 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 do not want surgery and
data is collected on the person's quality of life, health resource use and if they have knee replacement surgery in the long term.
1.2 Further research is recommended on AposHealth for:
people with knee osteoarthritis that meets the referral criteria for total knee replacement surgery but who cannot have surgery because it would be unsafe
people whose condition 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 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 studies compared AposHealth with a sham device. There is a lack of evidence directly comparing AposHealth with standard care, but this comparison is difficult because standard care is hard to define for this condition. There is limited clinical evidence for people who cannot have surgery because it would be unsafe, such as people who are frail and at a high risk of falls.
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 experience of using AposHealth agreed with this.
There is a lack of comparative evidence looking at knee surgery delay. Non-comparative 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 clinicians and patients who are using the technology in the NHS.
Cost-comparison analyses show that the potential cost savings from AposHealth mainly come from reduced standard care costs and reduced knee replacement surgeries. The analyses also suggest that AposHealth is cost saving by £1,958 per person when compared with standard care if knee surgery is delayed for 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.
There are no knee replacement costs for people who cannot have surgery because it would be unsafe, so both the potential cost saving and clinical benefit are uncertain. Therefore, AposHealth is not recommended for people who cannot have surgery, and more research is recommended.