COST-EFFECTIVENESS OF JOINT PROTECTION AND HAND EXERCISE FOR HAND OSTEOARTHRITIS

Oppong, Raymond; Jowett, Sue; Nicholls, Elaine; Whitehurst, David; Hill, Sue; Hammond, Alison; Hay, Elaine; Dziedzic, Krysia

Abstract

Background: European guidelines have proposed that joint protection and hand exercise should be used in the management of hand OA. However, the evidence regarding the cost-effectiveness of these interventions has not been well established. A 2x2 factorial trial was carried out to compare the effectiveness of joint protection (JP), hand exercise (HE), joint protection plus hand exercise and leaflet and advice (LA). The trial demonstrated JP was the most effective option as indicated by the primary outcome measure (OARSI/OMERACT responder criteria), at 6 month follow-up. The primary aim of this study is to assess the cost-effectiveness of management options for hand OA. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytic methodologies.

Methods: A cost-utility analysis was undertaken over a 12 month period. Patient level resource use and EQ-5D data were obtained from postal questionnaires, and mean costs and quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves constructed. The base case analysis used a within the table analysis methodology, which involves comparing LA, JP plus HE, JP alone and HE alone. Two further methods were explored: the at-the-margins approach, and a regression-based approach with or without an interaction term.

Results: 257 patients were randomized to receive one of the interventions. Mean costs (S.D.) recorded in each treatment arm were £50.24 (265.40) for LA, £104.40 (93.28) for JP plus HE, £82.29 (108.22) for JP and £57.21 (76.88) for HE. Mean QALYs (S.D.) associated with each trial arm were 0.662 (0.166) for LA, 0.658 (0.164) for JP plus HE, 0.659 (0.157) for JP and 0.681 (0.135) for HE. In the base case analysis, hand exercise was the most cost effective option with an ICER of £367 per QALY gained compared with leaflet and advice, and with an 80% chance of being cost-effective at a threshold of £30,000 per QALY gained. With the alternative analysis methods, HE remained the most cost-effective management strategy, with ICERs consistently less than £2,000 per QALY gained.

Conclusions: The results of this study showed that HE was the most cost-effective option irrespective of the adopted methodology. These findings should be viewed in the context of both management options being very inexpensive and the associated clinical findings that indicated joint protection was the most effective option at 6 months. Possible reasons for this disparity include the use of different outcome measures (responder criteria vs QALYs), measurement at different time points (6 months for the primary clinical outcome vs 12 months for the economic analysis), reduced statistical power and more generally, the distinct paradigmatic objectives of clinical and economic evaluation.

Citation

Oppong, R., Jowett, S., Nicholls, E., Whitehurst, D., Hill, S., Hammond, A., …Dziedzic, K. (2013). COST-EFFECTIVENESS OF JOINT PROTECTION AND HAND EXERCISE FOR HAND OSTEOARTHRITIS. Rheumatology, 52(S1),

• Journal Article Type: Conference Paper
• Online Publication Date: Apr 15, 2013
• Publication Date: Apr 15, 2013
• Deposit Date: Oct 17, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 52
• Issue: S1
• Publisher URL: https://academic.oup.com/rheumatology/article/52/suppl_1/i135/1929007