Oppong, R, Jowett, A, Nicholls, E, Whitehurst, DGT, Hill, S, Hammond, A, Hay, EM and Dziedzic, K 2014, 'Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial data' , Rheumatology .
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Objectives: Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand osteoarthritis (OA) is not well established. The primary aim of this study is to assess the cost-effectiveness (cost-utility) of these management options. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytic methodologies. Methods: A trial-based economic evaluation to assess the cost-utility of joint protection only, hand exercises only and joint protection plus hand exercises compared with leaflet and advice was undertaken over a 12-month period, from a UK National Health Service (NHS) perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves (CEACs) constructed. The base case analysis used a ‘within the table’ analysis methodology. Two further methods were explored: the ‘at the margins’ approach, and a regression-based approach with or without an interaction term. Results: Mean costs (QALYs) were £58.46 (0.662) for leaflet and advice, £92.12 (0.659) for joint protection, £64.51 (0.681) for hand exercises and £112.38 (0.658) for joint protection plus hand exercises. In the base case, hand exercises were the cost-effective option with an ICER of £318 per QALY gained. Hand exercises remained the most cost-effective management strategy when adopting alternative methodological approaches. Conclusion: This is the first trial evaluating the cost effectiveness of occupational therapy-supported approaches to self-management for hand OA. Our findings showed that hand exercises were the most cost-effective option.
|Themes:||Health and Wellbeing|
|Schools:||Schools > School of Health Sciences > Centre for Health Sciences Research|
|Journal or Publication Title:||Rheumatology|
|Publisher:||Oxford University Press|
|Funders:||Arthritis Research UK|
|Depositing User:||Professor Alison Hammond|
|Date Deposited:||31 Oct 2014 10:09|
|Last Modified:||12 May 2016 09:19|
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