The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis

Kigozi, Jesse; Oppong, Raymond; Paskins, Zoe; Bromley, Kieran; Lewis, Martyn; Hughes, Gemma; Hughes, Emily; Hennings, Susie; Cherrington, Andrea; Hall, Alison; Holden, Melanie A; Stevenson, Kay; Menon, Ajit; Roberts, Philip; Peat, George; Jinks, Clare; Foster, Nadine E; Mallen, Christian D; Roddy, Edward

Abstract

Objectives. Evidence for the comparative cost-effectiveness of intra-articular corticosteroid injection in people with hip osteoarthritis (OA) remains unclear. This study investigated the cost-effectiveness of best current treatment (BCT) comprising advice and education plus a single ultrasound-guided intraarticular hip injection (USGI) of 40mg triamcinolone acetonide and 4ml 1% lidocaine hydrochloride (BCT+US-T) versus BCT alone.

Methods. A trial-based cost-utility analysis of BCT+US-T compared with BCT was undertaken over 6 months. Patient-level cost data were obtained, and effectiveness was measured in terms of qualityadjusted life years (QALYs), allowing the calculation of cost per QALY gained from a United Kingdom (UK) National Health Service (NHS) perspective.

Results. BCT+US-T was associated with lower mean NHS costs (BCT+US-T minus BCT: £-161.6, 95% CI: £-583.95 to £54.18) and small but significantly higher mean QALYs than BCT alone over 6 months (BCT+US-T minus BCT: 0.0487, 95% CI: 0.0091, 0.0886). In the base case, BCT+US-T was the most cost-effective and dominated BCT alone. Differences in total costs were driven by number of visits to NHS consultants, private physiotherapists, and chiropractors, and hip surgery, which were more common with BCT alone than BCT+US-T.

Conclusion. Intra-articular corticosteroid injection plus BCT (BCT+US-T) for patients with hip OA results in lower costs and better outcomes, and is highly cost-effective, compared with BCT alone.

• Journal Article Type: Article
• Acceptance Date: Nov 19, 2023
• Online Publication Date: Dec 12, 2023
• Publication Date: Dec 12, 2023
• Deposit Date: Nov 24, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1093/rheumatology/kead659
• Keywords: economic evaluation, cost-effectiveness, cost-utility, hip osteoarthritis, corticosteroid injection.