Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy

Rodolfo Andres Hernandez, F. Sullivan, P. Donnan, I. Swann, Luke David Vale, BELLS Trial Group

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives. Bell's palsy (BP), which causes facial paralysis, affects 11-40 people per 100 000 per annum in the UK. Its cause is unknown but as many as 30% of patients have continuing facial disfigurement, psychological difficulties and occasionally facial pain. We present an randomised controlled trial (RCT)-based economic evaluation of the early administration of steroids (prednisolone) and/or antivirals (acyclovir) compared to placebo, for treatment of BP.

Methods. The RCT was not powered to detect differences in the cost-effectiveness; therefore, we adopted a decision analytic model approach as a way of gaining precision in our cost-effectiveness comparisons [e.g. prednisolone only (PO) versus acyclovir only versus prednisolone and acyclovir versus placebo, prednisolone versus no prednisolone (NP) and acyclovir versus no acyclovir]. We assumed that trial interventions affect the probability of being cured/not cured but their consequences are independent of the initial therapy. We used the percentage of individuals with a complete recovery (based on House-Brackmann grade = 1) at 9 months and Quality Adjusted Life Years (e.g. derived on responses to the Health Utilities Index III) as measures of effectiveness. Other parameter estimates were obtained from trial data.

Results. PO dominated-025EFi.e. was less costly and more effective-025EFall other therapy strategies in the four arms model [77% probability of cost-effective (CE)]. Moreover, Prednisolone dominated NP (77% probability of being CE at 30 pound 000 threshold) while no acyclovir dominated aciclovir (85% chance of CE), in the two arms models, respectively.

Conclusions. Treatment of BP with prednisolone is likely to be considered CE while treatment with acyclovir is highly unlikely to be considered CE. Further data on costs and utilities would be useful to confirm findings.

Original languageEnglish
Pages (from-to)137-144
Number of pages8
JournalFamily Practice
Volume26
Issue number2
DOIs
Publication statusPublished - 2009

Keywords

  • Acyclovir
  • bell's palsy
  • cost-effectiveness analysis
  • economic evaluation
  • prednisolone
  • MULTIPLE IMPUTATION
  • Anti-inflammatory agents
  • Antiviral agents

Cite this

Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy. / Hernandez, Rodolfo Andres; Sullivan, F.; Donnan, P.; Swann, I.; Vale, Luke David; BELLS Trial Group.

In: Family Practice, Vol. 26, No. 2, 2009, p. 137-144.

Research output: Contribution to journalArticle

Hernandez, Rodolfo Andres ; Sullivan, F. ; Donnan, P. ; Swann, I. ; Vale, Luke David ; BELLS Trial Group. / Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy. In: Family Practice. 2009 ; Vol. 26, No. 2. pp. 137-144.
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abstract = "Objectives. Bell's palsy (BP), which causes facial paralysis, affects 11-40 people per 100 000 per annum in the UK. Its cause is unknown but as many as 30{\%} of patients have continuing facial disfigurement, psychological difficulties and occasionally facial pain. We present an randomised controlled trial (RCT)-based economic evaluation of the early administration of steroids (prednisolone) and/or antivirals (acyclovir) compared to placebo, for treatment of BP.Methods. The RCT was not powered to detect differences in the cost-effectiveness; therefore, we adopted a decision analytic model approach as a way of gaining precision in our cost-effectiveness comparisons [e.g. prednisolone only (PO) versus acyclovir only versus prednisolone and acyclovir versus placebo, prednisolone versus no prednisolone (NP) and acyclovir versus no acyclovir]. We assumed that trial interventions affect the probability of being cured/not cured but their consequences are independent of the initial therapy. We used the percentage of individuals with a complete recovery (based on House-Brackmann grade = 1) at 9 months and Quality Adjusted Life Years (e.g. derived on responses to the Health Utilities Index III) as measures of effectiveness. Other parameter estimates were obtained from trial data.Results. PO dominated-025EFi.e. was less costly and more effective-025EFall other therapy strategies in the four arms model [77{\%} probability of cost-effective (CE)]. Moreover, Prednisolone dominated NP (77{\%} probability of being CE at 30 pound 000 threshold) while no acyclovir dominated aciclovir (85{\%} chance of CE), in the two arms models, respectively.Conclusions. Treatment of BP with prednisolone is likely to be considered CE while treatment with acyclovir is highly unlikely to be considered CE. Further data on costs and utilities would be useful to confirm findings.",
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T1 - Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy

AU - Hernandez, Rodolfo Andres

AU - Sullivan, F.

AU - Donnan, P.

AU - Swann, I.

AU - Vale, Luke David

AU - BELLS Trial Group

N1 - This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Family Practice following peer review. The definitive publisher-authenticated version Hernandez, RA., Sullivan, F., Donnan, P., Swann, I. & Vale, LD. BELLS Trial Group. (2009). 'Early Administration of Economic evaluation of prednisolone and/or acyclovir for Bell’s Palsy.' Family Practice 26(2) pp. 137-144. is available online at: http://dx.doi.org/10.1093/fampra/cmn107.

PY - 2009

Y1 - 2009

N2 - Objectives. Bell's palsy (BP), which causes facial paralysis, affects 11-40 people per 100 000 per annum in the UK. Its cause is unknown but as many as 30% of patients have continuing facial disfigurement, psychological difficulties and occasionally facial pain. We present an randomised controlled trial (RCT)-based economic evaluation of the early administration of steroids (prednisolone) and/or antivirals (acyclovir) compared to placebo, for treatment of BP.Methods. The RCT was not powered to detect differences in the cost-effectiveness; therefore, we adopted a decision analytic model approach as a way of gaining precision in our cost-effectiveness comparisons [e.g. prednisolone only (PO) versus acyclovir only versus prednisolone and acyclovir versus placebo, prednisolone versus no prednisolone (NP) and acyclovir versus no acyclovir]. We assumed that trial interventions affect the probability of being cured/not cured but their consequences are independent of the initial therapy. We used the percentage of individuals with a complete recovery (based on House-Brackmann grade = 1) at 9 months and Quality Adjusted Life Years (e.g. derived on responses to the Health Utilities Index III) as measures of effectiveness. Other parameter estimates were obtained from trial data.Results. PO dominated-025EFi.e. was less costly and more effective-025EFall other therapy strategies in the four arms model [77% probability of cost-effective (CE)]. Moreover, Prednisolone dominated NP (77% probability of being CE at 30 pound 000 threshold) while no acyclovir dominated aciclovir (85% chance of CE), in the two arms models, respectively.Conclusions. Treatment of BP with prednisolone is likely to be considered CE while treatment with acyclovir is highly unlikely to be considered CE. Further data on costs and utilities would be useful to confirm findings.

AB - Objectives. Bell's palsy (BP), which causes facial paralysis, affects 11-40 people per 100 000 per annum in the UK. Its cause is unknown but as many as 30% of patients have continuing facial disfigurement, psychological difficulties and occasionally facial pain. We present an randomised controlled trial (RCT)-based economic evaluation of the early administration of steroids (prednisolone) and/or antivirals (acyclovir) compared to placebo, for treatment of BP.Methods. The RCT was not powered to detect differences in the cost-effectiveness; therefore, we adopted a decision analytic model approach as a way of gaining precision in our cost-effectiveness comparisons [e.g. prednisolone only (PO) versus acyclovir only versus prednisolone and acyclovir versus placebo, prednisolone versus no prednisolone (NP) and acyclovir versus no acyclovir]. We assumed that trial interventions affect the probability of being cured/not cured but their consequences are independent of the initial therapy. We used the percentage of individuals with a complete recovery (based on House-Brackmann grade = 1) at 9 months and Quality Adjusted Life Years (e.g. derived on responses to the Health Utilities Index III) as measures of effectiveness. Other parameter estimates were obtained from trial data.Results. PO dominated-025EFi.e. was less costly and more effective-025EFall other therapy strategies in the four arms model [77% probability of cost-effective (CE)]. Moreover, Prednisolone dominated NP (77% probability of being CE at 30 pound 000 threshold) while no acyclovir dominated aciclovir (85% chance of CE), in the two arms models, respectively.Conclusions. Treatment of BP with prednisolone is likely to be considered CE while treatment with acyclovir is highly unlikely to be considered CE. Further data on costs and utilities would be useful to confirm findings.

KW - Acyclovir

KW - bell's palsy

KW - cost-effectiveness analysis

KW - economic evaluation

KW - prednisolone

KW - MULTIPLE IMPUTATION

KW - Anti-inflammatory agents

KW - Antiviral agents

U2 - 10.1093/fampra/cmn107

DO - 10.1093/fampra/cmn107

M3 - Article

VL - 26

SP - 137

EP - 144

JO - Family Practice

JF - Family Practice

SN - 0263-2136

IS - 2

ER -