Yue Gao, Hema Mistry, Fatema Dhaif, Blair Mcmurray, Sanjana Susarla, Seyran Naghdi
Two overarching thematic clusters were identified: (1) psychosocial and economic determinants, including loneliness and social isolation, social support and social capital, socioeconomic status, autonomy and independence, and life-course context; and (2) social programs and community-based interventions. Across studies, consistent evidence highlighted the protective role of social networks, social integration, and reduced loneliness in shaping health, well-being, and cognitive functioning. Autonomy and independence emerged as central elements of positive aging, influencing perceived control, meaning in life, and overall quality of life, while engagement in social, physical, and occupational activities supported the maintenance of resources in later adulthood.
OBJECTIVES: We evaluated the cost-effectiveness of weight-loss interventions for adults with knee osteoarthritis (OA) and obesity.
DESIGN: Systematic review and narrative synthesis.
DATA SOURCES: MEDLINE, EMBASE via Ovid, Global Index Medicus and Web of Science and a clinical trial registry (ClinicalTrials.gov), published up to June 2025.
ELIGIBILITY CRITERIA: English-language studies evaluating the cost-effectiveness of intentional weight-loss interventions in adults (≥18 years) with knee OA were included. Studies without cost-effectiveness outcomes, abstracts and conference proceedings were excluded.
DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted study characteristics and economic outcomes. A narrative synthesis was conducted and costs were standardised to 2024 British pounds.
RESULTS: 1014 references were identified; eight studies met inclusion criteria, including six model-based economic evaluations and two randomised trials. Most studies used lifetime horizons and presented data from healthcare or societal perspectives. Combined diet and exercise programmes showed quality-adjusted life years (QALY) gains of 0.05-0.16 with incremental cost-effectiveness ratios (ICERs) of £16 915 and £31 305 per QALY, while bariatric surgery yielded larger gains (0.81-1.7 QALYs) at lower ICERs (£4361 to £19 303 per QALY). Pharmacological interventions were effective but costly with ICER (£32 265 to £35 832 per QALY). Evidence regarding telehealth-only interventions was mixed, with reported ICERs ranging from no significant effect to £32 722 per QALY gained. The included studies fulfilled 79-86% of the criteria from Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and were all rated good on the Drummond checklist.
CONCLUSIONS: Using standard UK cost-effectiveness thresholds (£25 000 to £35 000 per QALY), bariatric surgery appears most likely to be cost-effective for patients with knee OA, although this conclusion is based primarily on US model-based evidence. Pharmacological therapies may be cost-effective, although their economic value is sensitive to drug pricing and willingness-to-pay thresholds. High-quality UK-based economic evaluations are needed to establish the cost-effectiveness of Glucagon-Like Peptide-1 (GLP-1) receptor agonists for knee OA.