The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis.

KIGOZI, Jesse, OPPONG, Raymond, PASKINS, Zoe, BROMLEY, Kieran, LEWIS, Martyn, HUGHES, Gemma, HUGHES, Emily, HENNINGS, Susie, CHERRINGTON, Andrea, HALL, Alison, HOLDEN, Melanie A, STEVENSON, Kay, MENON, Ajit, ROBERTS, Philip, PEAT, George, JINKS, Clare, FOSTER, Nadine E, MALLEN, Christian D and RODDY, Edward (2024). The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis. Rheumatology (Oxford, England): kead659.

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Abstract

Objectives

Evidence for the comparative cost-effectiveness of intra-articular corticosteroid injection in people with hip osteoarthritis (OA) remains unclear. This study investigated the cost-effectiveness of best current treatment (BCT) comprising advice and education plus a single ultrasound-guided intra-articular hip injection (USGI) of 40 mg triamcinolone acetonide and 4 ml 1% lidocaine hydrochloride (BCT+US-T) versus BCT alone.

Methods

A trial-based cost-utility analysis of BCT+US-T compared with BCT was undertaken over 6 months. Patient-level cost data were obtained, and effectiveness was measured in terms of quality-adjusted life years (QALYs), allowing the calculation of cost per QALY gained from a United Kingdom (UK) National Health Service (NHS) perspective.

Results

BCT+US-T was associated with lower mean NHS costs (BCT+US-T minus BCT: £-161.6, 95% CI: £-583.95 to £54.18) and small but significantly higher mean QALYs than BCT alone over 6 months (BCT+US-T minus BCT: 0.0487, 95% CI: 0.0091, 0.0886). In the base case, BCT+US-T was the most cost-effective and dominated BCT alone. Differences in total costs were driven by number of visits to NHS consultants, private physiotherapists, and chiropractors, and hip surgery, which were more common with BCT alone than BCT+US-T.

Conclusion

Intra-articular corticosteroid injection plus BCT (BCT+US-T) for patients with hip OA results in lower costs and better outcomes, and is highly cost-effective, compared with BCT alone.

Trial registration

EudraCT: 2014-003412-37 (August 8, 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (July 28, 2015).

Trial protocol

Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2153-0#citeas.

Doi

doi.org/10.1186/s12891-018-2153-0.

Item Type:	Article
Uncontrolled Keywords:	corticosteroid injection; cost-effectiveness; cost-utility; economic evaluation; hip osteoarthritis; 1103 Clinical Sciences; 1107 Immunology; 1117 Public Health and Health Services; Arthritis & Rheumatology; 3202 Clinical sciences; 3204 Immunology
Identification Number:	https://doi.org/10.1093/rheumatology/kead659
SWORD Depositor:	Symplectic Elements
Depositing User:	Symplectic Elements
Date Deposited:	08 Jan 2024 13:58
Last Modified:	08 Jan 2024 14:00
URI:	https://shura.shu.ac.uk/id/eprint/32946

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