The cost-effectiveness of different approaches to exercise and corticosteroid injection for subacromial pain (impingement) syndrome.

Oppong, Raymond; Jowett, Sue; Lewis, Martyn; Roddy, Edward; Ogollah, Reuben O; Zwierska, Irena; Datta, Praveen; Hall, Alison; Hay, Elaine; Shufflebotham, Julie; Stevenson, Kay; Van Der Windt, Danielle A; Young, Julie; Foster, Nadine E

Abstract

OBJECTIVES: To determine whether physiotherapist-led exercise intervention and ultrasound-guided subacromial corticosteroid injection is cost-effective when compared with standard advice and exercise leaflet and unguided injection in patients with subacromial pain (impingement) syndrome. METHODS: An incremental cost-utility analysis using patient responses to the five-level EuroQoL-5D (EQ-5D-5L) questionnaire was undertaken from a health care perspective alongside a 2x2 factorial randomised trial with 256 participants over a 12-month follow-up period. Uncertainty was explored through the use of cost-effectiveness acceptability curves. RESULTS: The cost-utility analysis indicated that physiotherapist-led exercise was associated with an incremental cost of £155.99 (95% CI: 69.02-241.93) and 0.031 (95% CI: -0.01-0.07) additional quality-adjusted life-years (QALYs), an incremental cost-effectiveness ratio (ICER) of £5,031 per QALY gained and an 85% chance of being cost-effective at a threshold of £20?000 per QALY gained compared with the advice and exercise leaflet. Ultrasound-guided injection was associated with an incremental cost of £15.89 (95% CI: -59.36-109.86) and 0.024 (95% CI: -0.02-0.07) additional QALYs, an ICER of £662 per QALY gained and a 83% chance of being cost-effective at a threshold of £20?000 per QALY gained compared with unguided injection. CONCLUSION: Physiotherapist-led exercise was cost-effective compared with the advice and exercise leaflet, and ultrasound-guided injection was cost-effective when compared with unguided injection. CLINICAL TRIAL REGISTRATION: ISRCTN, http://www.isrctn.com, ISRCTN42399123.

Citation

Oppong, R., Jowett, S., Lewis, M., Roddy, E., Ogollah, R. O., Zwierska, I., …Foster, N. E. (2021). The cost-effectiveness of different approaches to exercise and corticosteroid injection for subacromial pain (impingement) syndrome. Rheumatology, 60(9), 4175-4184. https://doi.org/10.1093/rheumatology/keaa903

• Journal Article Type: Article
• Acceptance Date: Jan 7, 2021
• Publication Date: Jan 7, 2021
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 60
• Issue: 9
• Pages: 4175-4184
• DOI: https://doi.org/10.1093/rheumatology/keaa903
• Keywords: cost-effectiveness, subacromial pain (impingement) syndrome, exercise, corticosteroid injection, EQ-5D
• Publisher URL: https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/keaa903/6067344?redirectedFrom=fulltext