Aileen R Neilson1, Gareth T Jones2,3, Gary J Macfarlane2,3, Karen Walker-Bone3,4, Kim Burton5, Peter J Heine6, Candy S McCabe7,8, Alex McConnachie9, Keith T Palmer3,4, David Coggon3,4, Paul McNamee1. 1. Health Economics Research Unit, University of Aberdeen, Aberdeen, UK. 2. Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK. 3. Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, UK. 4. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. 5. Centre for Applied Research in Health, University of Huddersfield, Huddersfield, UK. 6. Warwick Clinical Trials Unit, University of Warwick, Coventry, UK. 7. Royal United Hospitals NHS Foundation Trust, Bath, UK. 8. University of West of England, Bristol, UK. 9. Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Abstract
BACKGROUND: Arm pain is common, costly to health services and society. Physiotherapy referral is standard management, and while awaiting treatment, advice is often given to rest, but the evidence base is weak. OBJECTIVE: To assess the cost-effectiveness of advice to remain active (AA) versus advice to rest (AR); and immediate physiotherapy (IP) versus usual care (waiting list) physiotherapy (UCP). METHODS: Twenty-six-week within-trial economic evaluation (538 participants aged ≥18 years randomized to usual care, i.e. AA (n = 178), AR (n = 182) or IP (n = 178). Regression analysis estimated differences in mean costs and Quality-Adjusted Life Years (QALYs). Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were generated. Primary analysis comprised the 193 patients with complete resource use (UK NHS perspective) and EQ-5D data. Sensitivity analysis investigated uncertainty. RESULTS: Baseline-adjusted cost differences were £88 [95% confidence interval (CI): -14, 201) AA versus AR; -£14 (95% CI: -87, 66) IP versus UCP. Baseline-adjusted QALY differences were 0.0095 (95% CI: -0.0140, 0.0344) AA versus AR; 0.0143 (95% CI: -0.0077, 0.0354) IP versus UCP. There was a 71 and 89% probability that AA (versus AR) and IP (versus UCP) were the most cost-effective option using a threshold of £20,000 per additional QALY. The results were robust in the sensitivity analysis. CONCLUSION: The difference in mean costs and mean QALYs between the competing strategies was small and not statistically significant. However, decision-makers may judge that IP was not shown to be any more effective than delayed treatment, and was no more costly than delayed physiotherapy. AA is preferable to one that encourages AR, as it is more effective and more likely to be cost-effective than AR.
RCT Entities:
BACKGROUND: Arm pain is common, costly to health services and society. Physiotherapy referral is standard management, and while awaiting treatment, advice is often given to rest, but the evidence base is weak. OBJECTIVE: To assess the cost-effectiveness of advice to remain active (AA) versus advice to rest (AR); and immediate physiotherapy (IP) versus usual care (waiting list) physiotherapy (UCP). METHODS: Twenty-six-week within-trial economic evaluation (538 participants aged ≥18 years randomized to usual care, i.e. AA (n = 178), AR (n = 182) or IP (n = 178). Regression analysis estimated differences in mean costs and Quality-Adjusted Life Years (QALYs). Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were generated. Primary analysis comprised the 193 patients with complete resource use (UK NHS perspective) and EQ-5D data. Sensitivity analysis investigated uncertainty. RESULTS: Baseline-adjusted cost differences were £88 [95% confidence interval (CI): -14, 201) AA versus AR; -£14 (95% CI: -87, 66) IP versus UCP. Baseline-adjusted QALY differences were 0.0095 (95% CI: -0.0140, 0.0344) AA versus AR; 0.0143 (95% CI: -0.0077, 0.0354) IP versus UCP. There was a 71 and 89% probability that AA (versus AR) and IP (versus UCP) were the most cost-effective option using a threshold of £20,000 per additional QALY. The results were robust in the sensitivity analysis. CONCLUSION: The difference in mean costs and mean QALYs between the competing strategies was small and not statistically significant. However, decision-makers may judge that IP was not shown to be any more effective than delayed treatment, and was no more costly than delayed physiotherapy. AA is preferable to one that encourages AR, as it is more effective and more likely to be cost-effective than AR.
Authors: Heidi A Ojha; Nadia J Wyrsta; Todd E Davenport; William E Egan; Alfred C Gellhorn Journal: J Orthop Sports Phys Ther Date: 2016-01-11 Impact factor: 4.751
Authors: Kelvin P Jordan; Umesh T Kadam; Richard Hayward; Mark Porcheret; Catherine Young; Peter Croft Journal: BMC Musculoskelet Disord Date: 2010-07-02 Impact factor: 2.362
Authors: Gareth T Jones; Kathrin Mertens; Gary J Macfarlane; Keith T Palmer; David Coggon; Karen Walker-Bone; Kim Burton; Peter J Heine; Candy McCabe; Paul McNamee; Alex McConnachie Journal: BMC Musculoskelet Disord Date: 2014-03-10 Impact factor: 2.362
Authors: John D Childs; Julie M Fritz; Samuel S Wu; Timothy W Flynn; Robert S Wainner; Eric K Robertson; Forest S Kim; Steven Z George Journal: BMC Health Serv Res Date: 2015-04-09 Impact factor: 2.655
Authors: Gareth T Jones; Gary J Macfarlane; Karen Walker-Bone; Kim Burton; Peter Heine; Candida McCabe; Paul McNamee; Alex McConnachie; Rachel Zhang; Daniel Whibley; Keith Palmer; David Coggon Journal: RMD Open Date: 2019-03-04