Abstract
AIMS
A trial-based comparison of resource use, costs and quality of life outcomes of open and arthroscopic surgical management for rotator cuff tears in the United Kingdom National Health Service (UK NHS) was performed using individual participant data from the UKUFF randomised controlled trial.
METHODS
Using data from 273 participants, healthcare-related resource use, costs and quality-adjusted life years (QALYs) were estimated at 12 months and 24 months after surgery on an intention to treat basis with adjustment for covariates. Uncertainty around the incremental cost-effectiveness ratio (ICER) for arthroscopic versus open management at 24 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data.
RESULTS
There were no significant differences between the open and arthroscopic groups in terms of total mean resource use, cost or QALYs at any follow-up point. Open management dominated arthroscopic management in 59.8% of bootstrapped cost and effect differences. The probability that arthroscopic management was cost-effective compared to open management at a willingness-to-pay threshold of £20 000 per QALY gained was 20.9%.
CONCLUSION
There was no significant overall difference in resource use, costs or quality of life between open and arthroscopic management in the trial. There was uncertainty around which strategy was most cost-effective.
A trial-based comparison of resource use, costs and quality of life outcomes of open and arthroscopic surgical management for rotator cuff tears in the United Kingdom National Health Service (UK NHS) was performed using individual participant data from the UKUFF randomised controlled trial.
METHODS
Using data from 273 participants, healthcare-related resource use, costs and quality-adjusted life years (QALYs) were estimated at 12 months and 24 months after surgery on an intention to treat basis with adjustment for covariates. Uncertainty around the incremental cost-effectiveness ratio (ICER) for arthroscopic versus open management at 24 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data.
RESULTS
There were no significant differences between the open and arthroscopic groups in terms of total mean resource use, cost or QALYs at any follow-up point. Open management dominated arthroscopic management in 59.8% of bootstrapped cost and effect differences. The probability that arthroscopic management was cost-effective compared to open management at a willingness-to-pay threshold of £20 000 per QALY gained was 20.9%.
CONCLUSION
There was no significant overall difference in resource use, costs or quality of life between open and arthroscopic management in the trial. There was uncertainty around which strategy was most cost-effective.
| Original language | English |
|---|---|
| Pages (from-to) | 1648–1655 |
| Number of pages | 8 |
| Journal | The Journal of Bone and Joint Surgery - British volume |
| Volume | 98-B |
| Issue number | 12 |
| Publication status | Published - 1 Dec 2016 |
Bibliographical note
FUNDING & ACKNOWLEDGEMENTSThis project was funded by the NIHR Health Technology Assessment programme (project number 05/47/02) and is published in full in Health Technology Assessment; Vol. 19, No. 80. Further information available at: http://www.nets.nihr.ac.uk/projects/hta/054702
This paper presents independent research commissioned by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, CCF, NETSCC, the HTA programme or the Department of Health.
Due to the confidential nature of the trial data supporting this publication not all of the data can be made accessible to other researchers. Please contact the UKUFF study principal investigator Andrew Carr (andrew.carr@ndorms.ox.ac.uk) for more information.
The authors wish to thank the UKUFF trial collaborators for their contribution in managing the conduct of the trial, and for their comments on the interim economic results: Marion Campbell and Hannah Bruhn (Centre for Healthcare Randomised Trials, HSRU, University of Aberdeen), Jonathan Rees MD and David Beard (NDORMS, University of Oxford; NIHR Oxford Biomedical Research Centre), Jane Moser (NDORMS, University of Oxford), Raymond Fitzpatrick and Jill Dawson (NDPH, University of Oxford).
Keywords
- cost-effectiveness analysis
- economic evaluation
- rotator cuff tear
- cost-utility analysis