Journal Article (Refereed)
Joint protection and hand exercises: an economic evaluation comparing methods for the evaluation of factorial trials
Oppong, R & Jowett, S & Nicholls, E & Whitehurst, D & Hill, S & Hammond, A & Hay, E & Dziedzic, K & Dziedzic, K 2014, 'Joint protection and hand exercises: an economic evaluation comparing methods for the evaluation of factorial trials', Rheumatology.
Objective: Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand osteoarthritis (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 analytic 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 (NHS) 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 (CEACs) 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 (0.662) for leaflet and advice, £92.12 (0.659) for joint protection, £64.51 (0.681) for hand exercises and £112.38 (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.