Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials

Oppong, R; Jowett, S; Nicholls, E; Whitehurst, DGT; Hill, S; Hammond, A; Hay, EM; Dziedzic, K

Abstract

OBJECTIVES: Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand 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 analytical 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 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 were 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 (s.d. 0.662) for leaflet and advice, £92.12 (s.d. 0.659) for joint protection, £64.51 (s.d. 0.681) for hand exercises and £112.38 (s.d. 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.

Citation

Oppong, R., Jowett, S., Nicholls, E., Whitehurst, D., Hill, S., Hammond, A., …Dziedzic, K. (2015). Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials. Rheumatology, 54(5), 876 - 883. https://doi.org/10.1093/rheumatology/keu389

• Journal Article Type: Conference Paper
• Acceptance Date: Aug 4, 2014
• Online Publication Date: Oct 21, 2014
• Publication Date: 2015-05
• Publicly Available Date: May 26, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 54
• Issue: 5
• Pages: 876 - 883
• DOI: https://doi.org/10.1093/rheumatology/keu389
• Keywords: cost-effectiveness, cost-utility, hand osteoarthritis, factorial trial
• Publisher URL: https://doi.org/10.1093/rheumatology/keu389