Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain: An economic evaluation of data from a randomized controlled trial

Neilson, Aileen; Jones, Gareth; Macfarlane, Gary; Walker-Bone, Karen; Burton, Kim; Heine, Peter; McCabe, Candy; McConnachie, Alex; Palmer, Keith; Coggon, David; McNamee, Paul

Abstract

© 2018 The Author(s). Published by Oxford University Press. All rights reserved. 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) versus advice to rest (AR); and immediate physiotherapy (IP) versus usual care (waiting list) physiotherapy (UCP). Methods Twenty-six-week within-trial economic evaluation (538 participants aged ≥18 years randomized 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% confidence interval (CI): -14, 201) AA versus AR; -£14 (95% CI: -87, 66) IP versus UCP. Baseline-adjusted QALY differences were 0.0095 (95% CI: -0.0140, 0.0344) AA versus AR; 0.0143 (95% CI: -0.0077, 0.0354) IP versus UCP. There was a 71 and 89% probability that AA (versus AR) and IP (versus 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.

• Journal Article Type: Article
• Acceptance Date: May 4, 2018
• Publication Date: May 19, 2018
• Deposit Date: May 31, 2018
• Publicly Available Date: Jun 6, 2019
• Journal: Family Practice
• Print ISSN: 0263-2136
• Electronic ISSN: 1460-2229
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 36
• Issue: 2
• Pages: 179-186
• DOI: https://doi.org/10.1093/fampra/cmy047
• Keywords: arm pain, physiotherapy, economic evaluation, cost-effectiveness, trial, QALYs
• Public URL: https://uwe-repository.worktribe.com/output/866959
• Publisher URL: https://doi.org/10.1093/fampra/cmy047
• Additional Information: Additional Information : This is a pre-copyedited, author-produced version of an article accepted for publication in Family Practice following peer review. The version of record Aileen R Neilson, 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; Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain: an economic evaluation of data from a randomized controlled trial, Family Practice, , cmy047 is available online at: https://academic.oup.com/fampra/advance-article/doi/10.1093/fampra/cmy047/5033686 or https://doi.org/10.1093/fampra/cmy047
• Contract Date: May 31, 2018