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

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

doi:10.1093/rheumatology/kead659

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

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

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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 intra-articular hip injection (USGI) of 40 mg triamcinolone acetonide and 4 ml 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 quality-adjusted 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.

TRIAL REGISTRATION: EudraCT: 2014-003412-37 (August 8, 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (July 28, 2015).

TRIAL PROTOCOL: Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2153-0#citeas.

DOI: doi.org/10.1186/s12891-018-2153-0.

Original language	English
Article number	kead659
Pages (from-to)	1-8
Number of pages	8
Journal	Rheumatology (Oxford, England)
Early online date	12 Dec 2023
DOIs	https://doi.org/10.1093/rheumatology/kead659
Publication status	E-pub ahead of print - 12 Dec 2023

Bibliographical note

Keywords

economic evaluation
cost-effectiveness
cost–utility
hip osteoarthritis
corticosteroid injection

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Kigozi, J., Oppong, R., Paskins, Z., Bromley, K., Lewis, M., Hughes, G., Hughes, E., Hennings, S., Cherrington, A., Hall, A., Holden, M. A., Stevenson, K., Menon, A., Roberts, P., Peat, G., Jinks, C., Foster, N. E., Mallen, C. D., & Roddy, E. (2023). The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis. Rheumatology (Oxford, England), 1-8. Article kead659. Advance online publication. https://doi.org/10.1093/rheumatology/kead659

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

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 intra-articular hip injection (USGI) of 40 mg triamcinolone acetonide and 4 ml 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 quality-adjusted 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.TRIAL REGISTRATION: EudraCT: 2014-003412-37 (August 8, 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (July 28, 2015).TRIAL PROTOCOL: Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2153-0#citeas.DOI: doi.org/10.1186/s12891-018-2153-0.",

keywords = "economic evaluation, cost-effectiveness, cost–utility, hip osteoarthritis, corticosteroid injection",

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

note = "{\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.",

year = "2023",

month = dec,

day = "12",

doi = "10.1093/rheumatology/kead659",

language = "English",

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publisher = "Oxford University Press",

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Kigozi, J, Oppong, R, Paskins, Z, Bromley, K, Lewis, M, Hughes, G, Hughes, E, Hennings, S, Cherrington, A, Hall, A, Holden, MA, Stevenson, K, Menon, A, Roberts, P, Peat, G, Jinks, C, Foster, NE, Mallen, CD & Roddy, E 2023, 'The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis', Rheumatology (Oxford, England), pp. 1-8. https://doi.org/10.1093/rheumatology/kead659

TY - JOUR

T1 - The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis

AU - Kigozi, Jesse

AU - Oppong, Raymond

AU - Paskins, Zoe

AU - Bromley, Kieran

AU - Lewis, Martyn

AU - Hughes, Gemma

AU - Hughes, Emily

AU - Hennings, Susie

AU - Cherrington, Andrea

AU - Hall, Alison

AU - Holden, Melanie A

AU - Stevenson, Kay

AU - Menon, Ajit

AU - Roberts, Philip

AU - Peat, George

AU - Jinks, Clare

AU - Foster, Nadine E

AU - Mallen, Christian D

AU - Roddy, Edward

PY - 2023/12/12

Y1 - 2023/12/12

N2 - 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 intra-articular hip injection (USGI) of 40 mg triamcinolone acetonide and 4 ml 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 quality-adjusted 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.TRIAL REGISTRATION: EudraCT: 2014-003412-37 (August 8, 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (July 28, 2015).TRIAL PROTOCOL: Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2153-0#citeas.DOI: doi.org/10.1186/s12891-018-2153-0.

AB - 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 intra-articular hip injection (USGI) of 40 mg triamcinolone acetonide and 4 ml 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 quality-adjusted 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.TRIAL REGISTRATION: EudraCT: 2014-003412-37 (August 8, 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (July 28, 2015).TRIAL PROTOCOL: Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2153-0#citeas.DOI: doi.org/10.1186/s12891-018-2153-0.

KW - economic evaluation

KW - cost-effectiveness

KW - cost–utility

KW - hip osteoarthritis

KW - corticosteroid injection

U2 - 10.1093/rheumatology/kead659

DO - 10.1093/rheumatology/kead659

M3 - Article

C2 - 38085178

SN - 1462-0324

SP - 1

EP - 8

JO - Rheumatology (Oxford, England)

JF - Rheumatology (Oxford, England)

M1 - kead659

ER -

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

Abstract

Bibliographical note

Keywords

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