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Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the
Raymond Oppong1, Sue Jowett2, Elaine Nicholls3
1Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK Arthritis Research UK Primary Care Centre, Keele University, Keele, Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, UK, Faculty of Health Sciences, Simon Fraser University, Burnaby, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada and Centre for Health Sciences Research, University of Salford, Salford, UK.
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.
