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., Datta, P., Hall, A., Hay, E., Shufflebotham, J., Stevenson, K., Van Der Windt, D. A., Young, J., & 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
• Electronic ISSN: 1462-0332
• 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
• Public URL: https://keele-repository.worktribe.com/output/419148
• Publisher URL: https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/keaa903/6067344?redirectedFrom=fulltext
• PMID: 33410493