Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain: an economic evaluation of data from a randomised controlled trial

Aileen R Neilson, Gareth T Jones, Gary J Macfarlane, Karen Walker-Bone, Anthony Burton, Peter J Heine, Candy S McCabe, Alex McConnachie, Keith T Palmer, David Coggon, Paul McNamee

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background. Arm pain is common, costly to health services and society. Physiotherapy referral is standard management, and while awaiting treatment, advice is often given to rest, but the evidence base is weak.
Objective. To assess the cost-effectiveness of advice to remain active (AA) vs advice to rest (AR); and immediate physiotherapy (IP) vs usual care (waiting-list) physiotherapy (UCP).
Methods. 26-week within-trial economic evaluation (538 participants aged ≥18 years randomised to usual care i.e. AA(n=178), AR(n=182) or IP(n=178)). Regression analysis estimated differences in mean costs and Quality Adjusted Life Years (QALYs). Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were generated. Primary analysis comprised the 193 patients with complete resource use (UK NHS perspective) and EQ-5D data. Sensitivity analysis investigated uncertainty.
Results. Baseline adjusted cost differences were £88[95%CI:-14,201]) AA vs AR; -£14[95%CI:-87,66]) IP vs UCP. Baseline adjusted QALY differences were 0.0095[95% CI:-0.0140,0.0344]) AA vs AR; 0.0143[95%CI:-0.0077,0.0354]) IP vs UCP. There was a 71 % and 89% probability that AA (vs AR) and IP (vs UCP) were the most cost-effective option using a threshold of £20,000 per additional QALY. The results were robust in the sensitivity analysis.
Conclusion. The difference in mean costs and mean QALYs between the competing strategies was small and not statistically significant. However, decision-makers may judge that IP was not shown to be any more effective than delayed treatment, and was no more costly than delayed physiotherapy. AA is preferable to one that encourages AR, as it is more effective and more likely to be cost-effective than AR.
Original languageEnglish
JournalFamily Practice
DOIs
Publication statusPublished - 6 Jun 2018

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Quality-Adjusted Life Years
Cost-Benefit Analysis
Randomized Controlled Trials
Exercise
Costs and Cost Analysis
Pain
Waiting Lists
Uncertainty
Health Services
Referral and Consultation
Regression Analysis
Therapeutics

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Neilson, Aileen R ; Jones, Gareth T ; Macfarlane, Gary J ; Walker-Bone, Karen ; Burton, Anthony ; Heine, Peter J ; McCabe, Candy S ; McConnachie, Alex ; Palmer, Keith T ; Coggon, David ; McNamee, Paul. / Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain: an economic evaluation of data from a randomised controlled trial. In: Family Practice. 2018.
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title = "Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain: an economic evaluation of data from a randomised controlled trial",
abstract = "Background. Arm pain is common, costly to health services and society. Physiotherapy referral is standard management, and while awaiting treatment, advice is often given to rest, but the evidence base is weak.Objective. To assess the cost-effectiveness of advice to remain active (AA) vs advice to rest (AR); and immediate physiotherapy (IP) vs usual care (waiting-list) physiotherapy (UCP).Methods. 26-week within-trial economic evaluation (538 participants aged ≥18 years randomised to usual care i.e. AA(n=178), AR(n=182) or IP(n=178)). Regression analysis estimated differences in mean costs and Quality Adjusted Life Years (QALYs). Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were generated. Primary analysis comprised the 193 patients with complete resource use (UK NHS perspective) and EQ-5D data. Sensitivity analysis investigated uncertainty.Results. Baseline adjusted cost differences were £88[95{\%}CI:-14,201]) AA vs AR; -£14[95{\%}CI:-87,66]) IP vs UCP. Baseline adjusted QALY differences were 0.0095[95{\%} CI:-0.0140,0.0344]) AA vs AR; 0.0143[95{\%}CI:-0.0077,0.0354]) IP vs UCP. There was a 71 {\%} and 89{\%} probability that AA (vs AR) and IP (vs UCP) were the most cost-effective option using a threshold of £20,000 per additional QALY. The results were robust in the sensitivity analysis.Conclusion. The difference in mean costs and mean QALYs between the competing strategies was small and not statistically significant. However, decision-makers may judge that IP was not shown to be any more effective than delayed treatment, and was no more costly than delayed physiotherapy. AA is preferable to one that encourages AR, as it is more effective and more likely to be cost-effective than AR.",
author = "Neilson, {Aileen R} and Jones, {Gareth T} and Macfarlane, {Gary J} and Karen Walker-Bone and Anthony Burton and Heine, {Peter J} and McCabe, {Candy S} and Alex McConnachie and Palmer, {Keith T} and David Coggon and Paul McNamee",
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Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain: an economic evaluation of data from a randomised controlled trial. / Neilson, Aileen R; Jones, Gareth T; Macfarlane, Gary J; Walker-Bone, Karen; Burton, Anthony; Heine, Peter J; McCabe, Candy S; McConnachie, Alex; Palmer, Keith T; Coggon, David; McNamee, Paul.

In: Family Practice, 06.06.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain: an economic evaluation of data from a randomised controlled trial

AU - Neilson, Aileen R

AU - Jones, Gareth T

AU - Macfarlane, Gary J

AU - Walker-Bone, Karen

AU - Burton, Anthony

AU - Heine, Peter J

AU - McCabe, Candy S

AU - McConnachie, Alex

AU - Palmer, Keith T

AU - Coggon, David

AU - McNamee, Paul

PY - 2018/6/6

Y1 - 2018/6/6

N2 - Background. Arm pain is common, costly to health services and society. Physiotherapy referral is standard management, and while awaiting treatment, advice is often given to rest, but the evidence base is weak.Objective. To assess the cost-effectiveness of advice to remain active (AA) vs advice to rest (AR); and immediate physiotherapy (IP) vs usual care (waiting-list) physiotherapy (UCP).Methods. 26-week within-trial economic evaluation (538 participants aged ≥18 years randomised to usual care i.e. AA(n=178), AR(n=182) or IP(n=178)). Regression analysis estimated differences in mean costs and Quality Adjusted Life Years (QALYs). Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were generated. Primary analysis comprised the 193 patients with complete resource use (UK NHS perspective) and EQ-5D data. Sensitivity analysis investigated uncertainty.Results. Baseline adjusted cost differences were £88[95%CI:-14,201]) AA vs AR; -£14[95%CI:-87,66]) IP vs UCP. Baseline adjusted QALY differences were 0.0095[95% CI:-0.0140,0.0344]) AA vs AR; 0.0143[95%CI:-0.0077,0.0354]) IP vs UCP. There was a 71 % and 89% probability that AA (vs AR) and IP (vs UCP) were the most cost-effective option using a threshold of £20,000 per additional QALY. The results were robust in the sensitivity analysis.Conclusion. The difference in mean costs and mean QALYs between the competing strategies was small and not statistically significant. However, decision-makers may judge that IP was not shown to be any more effective than delayed treatment, and was no more costly than delayed physiotherapy. AA is preferable to one that encourages AR, as it is more effective and more likely to be cost-effective than AR.

AB - Background. Arm pain is common, costly to health services and society. Physiotherapy referral is standard management, and while awaiting treatment, advice is often given to rest, but the evidence base is weak.Objective. To assess the cost-effectiveness of advice to remain active (AA) vs advice to rest (AR); and immediate physiotherapy (IP) vs usual care (waiting-list) physiotherapy (UCP).Methods. 26-week within-trial economic evaluation (538 participants aged ≥18 years randomised to usual care i.e. AA(n=178), AR(n=182) or IP(n=178)). Regression analysis estimated differences in mean costs and Quality Adjusted Life Years (QALYs). Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were generated. Primary analysis comprised the 193 patients with complete resource use (UK NHS perspective) and EQ-5D data. Sensitivity analysis investigated uncertainty.Results. Baseline adjusted cost differences were £88[95%CI:-14,201]) AA vs AR; -£14[95%CI:-87,66]) IP vs UCP. Baseline adjusted QALY differences were 0.0095[95% CI:-0.0140,0.0344]) AA vs AR; 0.0143[95%CI:-0.0077,0.0354]) IP vs UCP. There was a 71 % and 89% probability that AA (vs AR) and IP (vs UCP) were the most cost-effective option using a threshold of £20,000 per additional QALY. The results were robust in the sensitivity analysis.Conclusion. The difference in mean costs and mean QALYs between the competing strategies was small and not statistically significant. However, decision-makers may judge that IP was not shown to be any more effective than delayed treatment, and was no more costly than delayed physiotherapy. AA is preferable to one that encourages AR, as it is more effective and more likely to be cost-effective than AR.

U2 - 10.1093/fampra/cmy047

DO - 10.1093/fampra/cmy047

M3 - Article

JO - Family Practice

JF - Family Practice

SN - 0263-2136

ER -