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Cost-effectiveness of a model consultation to support self-management in patients with osteoarthritis

Oppong, Raymond; Jowett, Sue; Lewis, Martyn; Clarkson, Kris; Paskins, Zoe; Croft, Peter; Edwards, John J; Healey, Emma; Jordan, Kelvin P; Morden, Andrew; Ong, Bie Nio; Porcheret, Mark; Finney, Andrew; Hay, Elaine; Dziedzic, Krysia

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Authors

Raymond Oppong

Sue Jowett

Kris Clarkson

Peter Croft

John J Edwards

Andrew Morden

Bie Nio Ong

Mark Porcheret



Abstract

Objectives: The aim of this study was to estimate the cost-effectiveness of a model OA consultation for OA to support self-management compared with usual care. Methods: An incremental cost-utility analysis using patient responses to the three-level EuroQoL-5D (EQ-5D) questionnaire was undertaken from a UK National Health Service perspective alongside a two-arm cluster-randomized controlled trial. Uncertainty was explored through the use of cost-effectiveness acceptability curves. Results: Differences in health outcomes between the model OA consultation and usual care arms were not statistically significant. On average, visits to the orthopaedic surgeon were lower in the model OA consultation arm by -0.28 (95% CI: -0.55, -0.06). The cost-utility analysis indicated that the model OA consultation was associated with a non-significant incremental cost of £-13.11 (95% CI: -81.09 to 54.85) and an incremental quality adjusted life year (QALY) of -0.003 (95% CI: -0.03 to 0.02), with a 44% chance of being cost-effective at a threshold of £20 000 per QALY gained. The percentage of participants who took time off and the associated productivity cost were lower in the model OA consultation arm. Conclusion: Implementing National Institute for Health and Care Excellence guidelines using a model OA consultation in primary care does not appear to lead to increased costs, but health outcomes remain very similar to usual care. Even though the intervention seems to reduce the demand for orthopaedic surgery, overall it is unlikely to be cost-effective.

Journal Article Type Article
Acceptance Date Jan 30, 2018
Online Publication Date Mar 14, 2018
Publication Date 2018-06
Publicly Available Date Mar 29, 2024
Journal Rheumatology
Print ISSN 1462-0324
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 57
Issue 6
Pages 1056-1063
DOI https://doi.org/10.1093/rheumatology/key037
Keywords primary care, cost-effectiveness, NICE osteoarthritis guidelines, ICECAP, EQ-5D, implementation
Publisher URL http://doi.org/10.1093/rheumatology/key037