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 (Corresponding Author), Gareth T. Jones, Gary J. MacFarlane, Karen Walker-Bone, Kim Burton, Peter J. Heine, Candy S. McCabe, Alex McConnachie, Keith T. Palmer, David Coggon, Paul McNamee

Research output: Contribution to journalArticle

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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. Twenty-six-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
Pages (from-to)179-186
Number of pages8
JournalFamily Practice
Volume36
Issue number2
Early online date6 Jun 2018
DOIs
Publication statusPublished - Apr 2019

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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

Keywords

  • arm pain
  • physiotherapy
  • economic evaluation
  • cost-effectiveness
  • trial
  • QALYs
  • Arm pain
  • THERAPY
  • LOW-BACK-PAIN

ASJC Scopus subject areas

  • Family Practice

Cite this

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. (Corresponding Author); Jones, Gareth T.; MacFarlane, Gary J.; Walker-Bone, Karen; Burton, Kim; Heine, Peter J.; McCabe, Candy S.; McConnachie, Alex; Palmer, Keith T.; Coggon, David; McNamee, Paul.

In: Family Practice, Vol. 36, No. 2, 04.2019, p. 179-186.

Research output: Contribution to journalArticle

Neilson, Aileen R. ; Jones, Gareth T. ; MacFarlane, Gary J. ; Walker-Bone, Karen ; Burton, Kim ; 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. 2019 ; Vol. 36, No. 2. pp. 179-186.
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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. Twenty-six-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.",
keywords = "arm pain, physiotherapy, economic evaluation, cost-effectiveness, trial, QALYs, Arm pain, THERAPY, LOW-BACK-PAIN",
author = "Neilson, {Aileen R.} and Jones, {Gareth T.} and MacFarlane, {Gary J.} and Karen Walker-Bone and Kim Burton and Heine, {Peter J.} and McCabe, {Candy S.} and Alex McConnachie and Palmer, {Keith T.} and David Coggon and Paul McNamee",
note = "Funding: Arthritis Research UK (Clinical Studies Grant, reference: 19231) Clinical trial registration: www.controlled-trials.com, reference: ISRCTN 79085082 Ethical approval: UK South Central (Hampshire A) Research Ethics Committee, reference: 11/SC/0107. Acknowledgements Prof. Kim Burton has been involved in the development of The Arm Book (ISBN: 978-0117069145), to which the experimental leaflet in this trial is related, and may receive future royalties on the booklet.",
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T1 - Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain

T2 - 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, Kim

AU - Heine, Peter J.

AU - McCabe, Candy S.

AU - McConnachie, Alex

AU - Palmer, Keith T.

AU - Coggon, David

AU - McNamee, Paul

N1 - Funding: Arthritis Research UK (Clinical Studies Grant, reference: 19231) Clinical trial registration: www.controlled-trials.com, reference: ISRCTN 79085082 Ethical approval: UK South Central (Hampshire A) Research Ethics Committee, reference: 11/SC/0107. Acknowledgements Prof. Kim Burton has been involved in the development of The Arm Book (ISBN: 978-0117069145), to which the experimental leaflet in this trial is related, and may receive future royalties on the booklet.

PY - 2019/4

Y1 - 2019/4

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. Twenty-six-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. Twenty-six-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.

KW - arm pain

KW - physiotherapy

KW - economic evaluation

KW - cost-effectiveness

KW - trial

KW - QALYs

KW - Arm pain

KW - THERAPY

KW - LOW-BACK-PAIN

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