***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Arthroscopic partial meniscectomy ( APM ) is extensively used to relieve pain in patients with symptomatic meniscal tear ( MT ) and knee osteoarthritis ( OA ) . Recent studies have failed to show the superiority of APM compared to other treatments . We aim to examine whether existing evidence is sufficient to reject use of APM as a cost-effective treatment for MT+OA . Methods We built a patient-level microsimulation using Monte Carlo methods and evaluated three strategies : Physical therapy ( ‘ PT ’ ) alone ; PT followed by APM if subjects continued to experience pain ( ‘ Delayed APM ’ ) ; and ‘ Immediate APM ’ .  Our subject population was US adults with symptomatic MT and knee OA over a 10 year time horizon . We assessed treatment outcomes using societal costs , quality -adjusted life years ( QALYs ) , and calculated incremental cost-effectiveness ratios ( ICERs ) , incorporating productivity costs as a sensitivity analysis . We also conducted a value-of-information analysis using probabilistic sensitivity analyses . Results Calculated ICERs were estimated to be $ 12,900/QALY for Delayed APM as compared to PT and $ 103,200/QALY for Immediate APM as compared to Delayed APM . In sensitivity analyses , inclusion of time costs made Delayed APM cost-saving as compared to PT . Improving efficacy of Delayed APM led to higher incremental costs and lower incremental effectiveness of Immediate APM in comparison to Delayed APM . Probabilistic sensitivity analyses indicated that PT had 3.0 % probability of being cost-effective at a willingness-to-pay ( WTP ) threshold of $ 50,000/QALY . Delayed APM was cost effective 57.7 % of the time at WTP = $ 50,000/QALY and 50.2 % at WTP = $ 100,000/QALY . The probability of Immediate APM being cost-effective did not exceed 50 % unless WTP exceeded $ 103,000/QALY . Conclusions We conclude that current cost-effectiveness evidence does not support unqualified rejection of either Immediate or Delayed APM for the treatment of MT+OA . The amount to which society would be willing to pay for additional information on treatment outcomes greatly exceeds the cost of conducting another r and omized controlled trial on APM For many years , the National Institute for Health and Care Excellence ( NICE ) has recommended use of the EQ-5D-3L ( 3L ) [ 1 ] and its value set for the UK [ 2 ] . Since 2011 , an exp and ed-level instrument , the EQ-5D-5L ( 5L ) , has been available [ 3 ] and value sets now exist to support its use , including a value set for Engl and [ 4 , 5 ] . This poses a challenge for NICE . Should it recommend the 5L rather than the 3L ? This is neither a trivial nor merely academic matter : the choice of whether to use the 5L ( and English value set ) or the 3L ( and UK value set ) is likely to impact estimates of quality -adjusted life-years ( QALYs ) and incremental cost-effectiveness ratios ( ICERs ) . The size and direction of that impact will depend on the disease and the nature of the health problems . In general , where technologies improve self-reported health , estimates of QALY gains will often be smaller with the 5L [ 6 ] . In contrast , where technologies extend the length of life , estimates of QALY gains will be higher ( to varying degrees ) : each year of additional life is assigned a higher utility . The ultimate impact on health technology assessment ( HTA ) will depend on whether the differences between the 3L and 5L push ICERs from one side of the cost-effectiveness threshold to the other . Given the implication s for NICE ’s technology appraisal process , and other decisions informed by EQ-5D data , the Department of Health for Engl and has called for an independent validation of the 5L value set , given its relevance to policy [ 7 ] . In 2017 , NICE released a ‘ position statement ’ [ 8 ] stating that : The 3L value set continues to be used for reference-case analyses . Where 5L data have been collected , reference-case analyses should calculate utilities by mapping the 5L descriptive system data onto the 3L value set , using the van Hout et al. [ 9 ] mapping function . NICE supports sponsors of prospect i ve clinical studies continuing to use the 5L to collect data on quality of life . A further position statement is planned for August 2018 , to be informed by evidence from various studies underway . These include studies commissioned by the English Department of Health to investigate the implication s for past NICE technology appraisal s had the 5L been used , and to collect 3L and 5L data in parallel to further improve functions for mapping from one to the other . Other studies , funded by the EuroQol Group , are also underway , investigating various aspects of the relationship between the 3L and 5L across disease areas . The 3L and its UK value set has occupied a special place in NICE ’s technology appraisal process since its inception , therefore any transition will inevitably pose challenges ; for example , reconciling potential inconsistencies between past and future decisions . Given that evidence will continue to be su bmi tted using both the 3L and 5L for years to come , if both value sets are able to be used , there is a risk of inconsistency between decisions being made in the future . HTA in other countries may also face similar issues . Given the difficulties with any transition away from the 3L , is there a case for NICE to adopt the 5L as its preferred instrument ? Papers in this issue of Pharmacoeconomics , which are cited in this commentary , address that question by investigating comparative performance of the 3L and 5L BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee . METHODS Patients with chronic osteoarthritis of the knee ( Kellgren grade < or = 2 ) were r and omly assigned to acupuncture ( n=150 ) , minimal acupuncture ( superficial needling at non-acupuncture points ; n=76 ) , or a waiting list control ( n=74 ) . Specialised physicians , in 28 outpatient centres , administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks . Patients completed st and ard question naires at baseline and after 8 weeks , 26 weeks , and 52 weeks . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index at the end of week 8 ( adjusted for baseline score ) . All main analyses were by intention to treat . RESULTS 294 patients were enrolled from March 6 , 2002 , to January 17 , 2003 ; eight patients were lost to follow-up after r and omisation , but were included in the final analysis . The mean baseline-adjusted WOMAC index at week 8 was 26.9 ( SE 1.4 ) in the acupuncture group , 35.8 ( 1.9 ) in the minimal acupuncture group , and 49.6 ( 2.0 ) in the waiting list group ( treatment difference acupuncture vs minimal acupuncture -8.8 , [ 95 % CI -13.5 to -4.2 ] , p=0.0002 ; acupuncture vs waiting list -22.7 [ -27.5 to -17.9 ] , p<0.0001 ) . After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant ( p=0.08 ) . INTERPRETATION After 8 weeks of treatment , pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee . However , this benefit decreases over time OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone Background Few population -based studies have examined the prevalence of foot pain in the general community . The aims of this study were therefore to determine the prevalence , correlates and impact of foot pain in a population -based sample of people aged 18 years and over living in the northwest region of Adelaide , South Australia . Methods The North West Adelaide Health Study is a representative longitudinal cohort study of n = 4,060 people r and omly selected and recruited by telephone interview .  The second stage of data collection on this cohort was undertaken between mid 2004 and early 2006 . In this phase , information regarding the prevalence of musculoskeletal conditions was included . Overall , n = 3,206 participants returned to the clinic during the second visit , and as part of the assessment were asked to report whether they had pain , aching or stiffness on most days in either of their feet . Data were also collected on body mass index ( BMI ) ; major medical conditions ; other joint symptoms and health-related quality of life ( the Medical Outcomes Study Short Form 36 [ SF-36 ] ) . Results Overall , 17.4 % ( 95 % confidence interval 16.2 – 18.8 ) of participants indicated that they had foot pain , aching or stiffness in either of their feet . Females , those aged 50 years and over , classified as obese and who reported knee , hip and back pain were all significantly more likely to report foot pain . Respondents with foot pain scored lower on all domains of the SF-36 after adjustment for age , sex and BMI . Conclusion Foot pain affects nearly one in five of people in the community , is associated with increased age , female sex , obesity and pain in other body regions , and has a significant detrimental impact on health-related quality of life OBJECTIVE To evaluate the clinical effectiveness of manual physiotherapy and /or exercise physiotherapy in addition to usual care for patients with osteoarthritis ( OA ) of the hip or knee . DESIGN In this 2 × 2 factorial r and omized controlled trial , 206 adults ( mean age 66 years ) who met the American College of Rheumatology criteria for hip or knee OA were r and omly allocated to receive manual physiotherapy ( n = 54 ) , multi-modal exercise physiotherapy ( n = 51 ) , combined exercise and manual physiotherapy ( n = 50 ) , or no trial physiotherapy ( n = 51 ) . The primary outcome was change in the Western Ontario and McMaster osteoarthritis index ( WOMAC ) after 1 year . Secondary outcomes included physical performance tests . Outcome assessors were blinded to group allocation . RESULTS Of 206 participants recruited , 193 ( 93.2 % ) were retained at follow-up . Mean ( SD ) baseline WOMAC score was 100.8 ( 53.8 ) on a scale of 0 - 240 . Intention to treat analysis showed adjusted reductions in WOMAC scores at 1 year compared with the usual care group of 28.5 ( 95 % confidence interval ( CI ) 9.2 - 47.8 ) for usual care plus manual therapy , 16.4 ( -3.2 to 35.9 ) for usual care plus exercise therapy , and 14.5 ( -5.2 to 34.1 ) for usual care plus 
    Output:
    
A matrix presentation of costs mapped with outcomes indicated increasing costs with either no difference or improvements in clinical effectiveness .