The cost-effectiveness of different approaches to exercise and corticosteroid injection for subacromial pain (impingement) syndrome

Raymond Oppong, Sue Jowett, Martyn Lewis, Edward Roddy, Reuben Ogollah, Irena Zwierska, Praveen Datta, Alison Hall, Elaine Hay, Julie Shufflebotham, Kay Stevenson, Danielle A. van der Windt, Julie Young, Nadine Foster

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Abstract

Objectives
To determine whether physiotherapist-led exercise intervention and US-guided subacromial CS 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 healthcare perspective alongside a 2 × 2 factorial randomized 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 £5031 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. US-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 US-guided injection was cost-effective when compared with unguided injection.

Clinical trial registration
ISRCTN, http://www.isrctn.com, ISRCTN42399123
Original languageEnglish
Article numberkeaa903
JournalRheumatology
Early online date7 Jan 2021
DOIs
Publication statusE-pub ahead of print - 7 Jan 2021

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