Abstract
Objectives
The aim of this study was to estimate the cost-effectiveness of a model OA consultation for osteoarthritis to support self-management compared with usual care.
Methods
An incremental cost-utility analysis using patient responses to the 3-level EQ-5D questionnaire was undertaken from a UK National Health Service perspective alongside a two-arm cluster-randomised controlled trial. Uncertainty was explored through the use of cost-effectiveness acceptability curves.
Results
Differences in health outcomes between the model OA consultation and usual care arms were not statistically significant. On average, visits to the orthopaedic surgeon were lower in the model OA consultation arm -0.28 (95% CI: -0.55, -0.06). The cost-utility analysis indicated that the model OA consultation was associated with a non-significant incremental cost of £-13.11 (95% CI: -81.09, 54.85) and an incremental QALY of -0.003 (95% CI: -0.03, 0.02), with a 44% chance of being cost-effective at a threshold of £20,000 per QALY gained. The percentage of participants who took time off and the associated productivity cost was lower in the model OA consultation arm.
Conclusion
Implementing NICE guidelines using a model OA consultation in primary care does not appear to lead to increased costs, but health outcomes remain very similar to usual care. Even though the intervention seems to reduce the demand for orthopaedic surgery, overall it is unlikely to be cost-effective.
The aim of this study was to estimate the cost-effectiveness of a model OA consultation for osteoarthritis to support self-management compared with usual care.
Methods
An incremental cost-utility analysis using patient responses to the 3-level EQ-5D questionnaire was undertaken from a UK National Health Service perspective alongside a two-arm cluster-randomised controlled trial. Uncertainty was explored through the use of cost-effectiveness acceptability curves.
Results
Differences in health outcomes between the model OA consultation and usual care arms were not statistically significant. On average, visits to the orthopaedic surgeon were lower in the model OA consultation arm -0.28 (95% CI: -0.55, -0.06). The cost-utility analysis indicated that the model OA consultation was associated with a non-significant incremental cost of £-13.11 (95% CI: -81.09, 54.85) and an incremental QALY of -0.003 (95% CI: -0.03, 0.02), with a 44% chance of being cost-effective at a threshold of £20,000 per QALY gained. The percentage of participants who took time off and the associated productivity cost was lower in the model OA consultation arm.
Conclusion
Implementing NICE guidelines using a model OA consultation in primary care does not appear to lead to increased costs, but health outcomes remain very similar to usual care. Even though the intervention seems to reduce the demand for orthopaedic surgery, overall it is unlikely to be cost-effective.
| Original language | English |
|---|---|
| Journal | Rheumatology |
| Early online date | 14 Mar 2018 |
| DOIs | |
| Publication status | E-pub ahead of print - 14 Mar 2018 |
Keywords
- ICECAP
- implementation
- Primary care
- cost-effectiveness
- NICE osteoarthritis guidelines
- EQ5D