Oppong, R ORCID: https://orcid.org/0000-0002-0815-4616, Jowett, S ORCID: https://orcid.org/0000-0001-8936-3745, Lewis, M ORCID: https://orcid.org/0000-0002-3667-132X, Roddy, E ORCID: https://orcid.org/0000-0002-8954-7082, Ogollah, RO ORCID: https://orcid.org/0000-0002-5777-4117, Zwierska, I, Datta, P, Hall, A, Hay, E ORCID: https://orcid.org/0000-0002-9545-4296, Shufflebotham, J, Stevenson, K ORCID: https://orcid.org/0000-0002-2518-4227, van der Windt, DA ORCID: https://orcid.org/0000-0002-7248-6703, Young, J and Foster, NE ORCID: https://orcid.org/0000-0003-4429-9756 (2021) The cost-effectiveness of different approaches to exercise and corticosteroid injection for subacromial pain (impingement) syndrome. Rheumatology.

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Abstract

OBJECTIVES: To determine whether physiotherapist-led exercise intervention and ultrasound-guided subacromial corticosteroid injection is cost-effective when compared with standard advice and exercise leaflet and unguided injection in patients with subacromial pain (impingement) syndrome. METHODS: An incremental cost-utility analysis using patient responses to the five-level EuroQoL-5D (EQ-5D-5L) questionnaire was undertaken from a health care perspective alongside a 2x2 factorial randomised trial with 256 participants over a 12-month follow-up period. Uncertainty was explored through the use of cost-effectiveness acceptability curves. RESULTS: The cost-utility analysis indicated that physiotherapist-led exercise was associated with an incremental cost of £155.99 (95% CI: 69.02-241.93) and 0.031 (95% CI: -0.01-0.07) additional quality-adjusted life-years (QALYs), an incremental cost-effectiveness ratio (ICER) of £5,031 per QALY gained and an 85% chance of being cost-effective at a threshold of £20 000 per QALY gained compared with the advice and exercise leaflet. Ultrasound-guided injection was associated with an incremental cost of £15.89 (95% CI: -59.36-109.86) and 0.024 (95% CI: -0.02-0.07) additional QALYs, an ICER of £662 per QALY gained and a 83% chance of being cost-effective at a threshold of £20 000 per QALY gained compared with unguided injection. CONCLUSION: Physiotherapist-led exercise was cost-effective compared with the advice and exercise leaflet, and ultrasound-guided injection was cost-effective when compared with unguided injection. CLINICAL TRIAL REGISTRATION: ISRCTN, http://www.isrctn.com, ISRCTN42399123.

Item Type: Article
Additional Information: © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
Uncontrolled Keywords: cost-effectiveness, subacromial pain (impingement) syndrome, exercise, corticosteroid injection, EQ-5D
Subjects: R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
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Depositing User: Symplectic
Date Deposited: 05 Feb 2021 11:35
Last Modified: 29 Apr 2021 14:17
URI: https://eprints.keele.ac.uk/id/eprint/9140

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